Large intracerebral hemorrhage secondary to functional endoscopic sinus surgery: risks in approaching anterior skull base

Rationale/objective This is a rare case of a 54-years-old man affected by chronic erosive sinusitis who developed a large frontal intracerebral hemorrhage after functional endoscopic sinus surgery (FESS). The patient underwent urgent surgical hemorrhage evacuation and anterior skull-base bone defect repair. Methods We analyzed the possible causes of this complication following FEES, focusing on anterior skull base bone erosion by chronic sinusitis, anterior ethmoidal artery injury and/or aneurysm, and direct frontal lobe trauma. Results The neurological outcome was good, and at three months follow-up, the patient showed only minor cognitive deficit and no cerebrospinal fluid leak. Conclusion During FESS, anatomical bone alteration of the anterior skull base such as in patients affected by chronic sinusitis, may increase the risk of severe complications such as intracerebral hemorrhage. A careful preoperative evaluation is mandatory.