The low skull base: an invitation to disaster.

Area of Science:

• Neurosurgery
• Otolaryngology
• Anatomical Studies

Background:

• Safe endoscopic sinus surgery necessitates precise anatomical knowledge, including variations.
• A lower-than-normal skull base/cribriform plate is a critical anatomical variation.
• Failure to identify this variation preoperatively can result in direct brain entry and severe injury.

Observation:

• Four cases of chronic rhinosinusitis with low anterior skull base/cribriform plate anatomy were reviewed.
• These cases involved major surgical complications due to the anatomical variation.
• The review focused on instances where the skull base or cribriform plate was unusually low.

Findings:

• All four patients experienced complications, including brain entry, cerebrospinal fluid leaks, or brain hemorrhage.
• One patient tragically died, while three suffered significant neurological deficits.
• Biopsy specimens confirmed unintended entry into the skull base/cribriform plate of the brain.

Implications:

• Preoperative identification of skull base and cribriform plate anatomy is paramount.
• Endoscopic and CT scan assessments are vital for detecting anatomical abnormalities.
• Careful preoperative and operative planning is essential to prevent catastrophic surgical outcomes.