Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children.

Abstract Objectives To report the long-term sinonasal complications after endoscopic repair of anterior skull base fracturesin children. This study describes mucoceleformation in 6 patients treated endoscopically for posttraumatic CSF fistulae. We aim to address possible etiologic factors, specific treatments and follow-up modalities. Patients and methods 12 children, mean age 5.8 years (3–10), treated endoscopically at our institution between 2004 and 2010 for an anterior cranial base fracture complicated by a CSF fistula. An iatrogenic mucocelewas observed in 6 cases. A retrospective review of the files of these 6 patients was carried out demonstrating demographic characteristics, presenting signs/symptoms, site of skull base defect, repair technique, timing and onset of the mucoceles, their presentation and management. A systematic CT-scan and/or MRI was carried out at 3 months, 1 year and then annually. Results 3 patients presented after cranial trauma with persistent CSF nasal leak, and 4 with meningitis. Posttraumatic defects reached the posterior wall of the frontal sinusand the junction of ethmoid and frontal bonein 3 cases, and the cribriform platein 3 cases. Endoscopic closure was performed in all cases, with the middle turbinate as an overlay patch. No recurrence of a CSF leak was observed. After a mean period of 16 months, a single iatrogenic mucocelewas observed in 4 patients (radiological detection only), and multiple mucocelesin 2 patients. Surgical treatment was advocated in cases of proptosis, quick expansion of the mucoceleleading to sinus bony wall remodelling or erosion (2 cases), and meningitis related to an erosion of the cribriform plateby the mucocele. Three mucoceleswere successfully treated endoscopically, and 1 required an external approach. Conclusion Mucoceleincidence after endoscopic repair of skull base fracturesin children is not insignificant (50% in our 12 patients series). Paediatric anatomical features, cranial trauma, and the transethmoidal approach may play a role in mucocelepathogenesis. Long-term clinical and radiological follow-up is therefore recommended. These mucocelesmay be managed endoscopically with good outcomes.