The low skull base-is it important?

PURPOSE OF REVIEW: Little is published regarding variations of skull-base anatomy and their relevance to the performance of endoscopic sinus surgery. Several catastrophic complications have occurred in patients with low-lying skull-base variation. This review's purpose is to make the reader aware of skull-base variation, their recognition, and a surgical plan for sinus surgery in these patients.

RECENT FINDINGS: Only a few papers are available for review discussing variations of the low-skull base. Recent findings in reviewing multiple CT scan indicate several variations of the skull. It has also been noted that there are variations of thickening in the skull (ie, lateral ethmoid, thicker bone, more medial, thinner bone). Several case reports have surfaced reflecting how a low-lying skull-base can play a role in brain-related complications. These figures are reviewed.

SUMMARY: A knowledge of orbital and skull-base variations preoperatively can help plan the surgical procedure and avoid major complication. The preoperative CT scan is the key to preoperative knowledge. The use of special techniques to aid in localization of a low-lying skull-base including image computer guidance is recommended.