Subdural haematoma after endoscopic skull base surgery: case report and lesson learned

Clin Neurol Neurosurg. 2011 Jul;113(6):496-8. doi: 10.1016/j.clineuro.2011.01.009. Epub 2011 Mar 2.


We report a case of a left fronto-temporo-parietal subdural haematoma that emerged as a complication of an endonasal endoscopic resection of a sinonasal adenocarcinoma of the left ethmoidal region. During the first surgical intervention, following oncological principles, the dura mater above the ethmoidal plate was removed and a skull base plasty was performed. In the post-operative phase a massive cerebrospinal fluid leak was observed and a revision duraplasty was performed the following day. Subsequently the patient was discharged on day 8 with no signs of CSF leakage. At the three month follow-up MR examination a subdural haematoma was observed and then treated by the neurosurgeon in a standard fashion. The collection was quite asymptomatic and discovered accidentally. We strongly advise the role of early post-op neuroimaging in every patient undergoing skull base procedures. We maintain that a massive CSF leak, that causes a significant reduction of intracranial pressure, should be managed as a surgical emergency, in order to reduce the risk of subdural haematoma.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / surgery
  • Cerebrospinal Fluid Leak
  • Cerebrospinal Fluid Rhinorrhea / etiology
  • Endoscopy / adverse effects*
  • Ethmoid Bone / pathology
  • Ethmoid Bone / surgery
  • Hematoma, Subdural / etiology*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Postoperative Complications / pathology*
  • Postoperative Complications / therapy
  • Skull Base / surgery*
  • Skull Base Neoplasms / surgery
  • Tomography, X-Ray Computed