ИСТИНА

Purpose of the study: to analyze the personal experience of treating patients with complex skull base defects complicated by pneumocephalus and to develop a treatment algorithm for this pathology based on the results. Materials and methods A retrospective review of a series of 22 patients with nasal cerebrospinal fluid leakage accompanied by pneumocephalus, treated at our neurosurgical center between 2001 and 2017. The demographic characteristics of the patients (sex, age), clinical data (etiology, symptomatology, X-ray findings), and surgical treatment aspects (approaches, reconstructive materials) were taken into account. Treatment results, including the relapse rate and postoperative complications, were analyzed. The obtained data was compared with the results of the literature review. Results In a series of 22 patients with nasal cerebrospinal fluid leakage accompanied by pneumocephaly, the mean age was 41 years (range 17-64 years), with 13 (59%) men and 9 (41%) women. By etiology, 12 cases (55%) had traumatic causes, 8 (36%) – iatrogenic and 2 (9%) were spontaneous. Clinically the patients presented with the following manifestations: psycho-neurological symptoms (41%), nasal cerebrospinal fluid leakage (36%), impaired consciousness (27%), and meningitis (23%). Computed tomography and magnetic resonance imaging, demonstrated areas of pneumatization in the brain tissue and the lateral ventricles. A total of 24 surgical interventions (including revision surgery) were performed in 22 patients. All patients underwent endoscopic endonasal reconstruction of the complex skull base defects. The reconstructive tissues used included the fascia lata of the thigh and adipose tissue (77%), fascia lata of the thigh and cartilage/bone from the nasal septum (14%), and a nasoseptal flap on a feeding pedicle (9%). The success rate of the reconstructive interventions was 91%. Relapses occurred in 2 (9%) cases. Postoperative complications in the form of meningitis developed in 4 patients (18%). Discussion The term pneumocephalus represents air accumulation in the cavity of the skull. This condition is caused by a defect in the base of the skull in conjunction with negative intracranial pressure. According to world literature, the incidence of posttraumatic pneumocephalus varies between 0.5-1% among all craniocerebral trauma cases. Fifteen articles published from 1996 to 2016 were identified. Our data on etiology, symptomatology and treatment is in line with world literature data. Most authors agree that the presence of a defect of the skull base requires surgical reconstruction. Currenlty the surgical method of choice is the endoscopic endonasal technique. Conclusion 1. In cases of a history of nasal cerebrospinal fluid leaks, if the patient's condition worsens with onset of cerebral and psychiatric symptoms, it is important to take into account the risk of pneumocephalus development, as its timely diagnosis facilitates correct treatment choice. 2. Once the diagnosis of pneumocephalus is suspected, the patient has a history of nasal cerebrospinal fluid leaks and CT data demonstrates the presence of skull base defects, surgical treatment becomes the method of choice to prevent infectious complications