Skull base injury with extensive pneumocephalus after transnasal endotracheal intubation

Iatrogenic injuries of the frontal skull base commonly occur during endoscopic sinus surgery. In this paper, we present a rare case of cranial base injury after transnasal endotracheal intubation for dental surgery. A 61-year-old otherwise healthy man presented at the emergency department with headache, right leg weakness and watery nasal discharge on the left side. He underwent a dental surgery under general anaesthesia with transnasal endotracheal intubation 2 days earlier. A CT of the head showed a bone defect of the left skull base with a bifrontal pneumocephalus. Urgent endoscopic sinus surgery with exposure of the skull base was performed. The anterior part of the middle nasal turbinate was found dislocated and resulted in an injury of the lateral lamella of the cribriform plate. After endoscopic reconstruction of the bone defect, the patient showed a rapid improvement of symptoms. Two years after surgery the patient is free of symptoms.