Frontal Lobe Herniation After Endoscopic Anterior Skull Base Resection: A Rare Complication

Sinonasal tumors represent a small percentage of head and neck malignancies. Advances in endonasal surgery have revolutionized the management of these tumors, offering improved oncological outcomes and reduced morbidity for selected cases compared with traditional open approaches. However, this kind of approaches often leads to large defects resulting in complications, including cerebrospinal fluid leaks or meningitis. Cerebral herniation is a rare, often unknown, and underreported complication in the literature. This article presents the case of a 33-year-old male patient with no medical history who underwent endoscopic resection of an olfactory esthesioneuroblastoma, followed with a frontal lobe herniation. We aimed to highlight the possible pathophysiology and several management challenges. The case underscores the importance of considering multifactorial causes of herniation. For our patient, we found that elevated intracranial pressure due to meningitis is a possible contributing factor. Even though cerebral herniation is a rare complication after endoscopic anterior skull base resection and reconstruction, its understanding is mandatory to identify several contributing factors preoperatively to optimize patient management and ensure a better outcome.