Anterior skull base trauma during endoscopic sinus surgery for nasal polyposis preferred sites for iatrogenic injuries

Objective: To determine typical locations for traumatic lesions of the ante rior skull base during endoscopic sinus surgery. Study Design: In this retr ospective study 12 patients were included who had undergone endoscopic sinu s surgery for nasal polyposis and were referred to the author for revision surgery after iatrogenic trauma of the anterior skull base during the proce dure. Each patient had been operated by a different surgeon, all of the phy sicians being in on advanced stage of their surgical career and being board certified otolaryngologists. Results: During endoscopically controlled rev ision surgery, all lesions could be detected, 10 of them being located in t he ethmoid roof, while one injury had occurred in the lateral lamella of th e cribriform plate and another one in the olfactory groove between the medi al turbinate and the nasal septum. Conclusion: In contrast to reports in th e literature, the preferred site for anterior skull base injuries during en doscopic sinus surgery in our group was not the lateral lamella of the crib riform plate, but the anterior part of the ethmoid roof, just behind the fr ontal recess. Apparently the course of the ethmoid roof might be misinterpr eted during sinus surgery even by surgeons who are familiar with the operat ive technique