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Don't sue the surgeon: remineralisation of the skull base or a defect that never existed?

Published online by Cambridge University Press:  07 September 2011

C Hopkins*
Affiliation:
Department of Otolaryngology, Guy's Hospital, London, UK
S Dhillon
Affiliation:
Department of Otolaryngology, Guy's Hospital, London, UK
G Rogers
Affiliation:
Department of Otolaryngology, Princess Alexandra Hospital, Harlow, UK
D Roberts
Affiliation:
Department of Otolaryngology, Guy's Hospital, London, UK
*
Address for correspondence: Ms Claire Hopkins, Carmay, Chelsfield Lane, Orpington BR6 7RR, UK E-mail: [email protected]

Abstract

Introduction:

Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.

Case report:

A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.

Discussion and conclusion:

We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2011

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