Recognition and Diagnosis of the Complication
During both open and arthroscopic surgeries, the GF perforation may be directly visualized during surgery. However, small perforations may be missed and even concealed by the fibrocartilage lining the fossa, in which case, the symptoms associated with perforation into the middle cranial fossa may present in the immediate postoperative period. Complaints of a headache, nausea, vomiting, vertigo, and palsies of the cranial nerves of the ipsilateral side are all associated with raised intracranial pressure and should be recognized. Delayed bleeding or a hematoma within the intracranial fossa can be difficult to detect, and signs such as headache, irritability, nausea or vomiting, and change in behavior should be considered an indication of cerebral irritation. If there is a suspicion of GF perforation, a head CT without contrast should be obtained immediately.
Arthroscopic irrigation fluid within the cranial cavity can also cause symptoms associated with increased intracranial pressure and cerebral irritation that is selflimiting. Physiological reabsorption of the fluid leads to an eventual reduction in pressure and resolution of the symptoms. However, close monitoring of vital parameters including ICP measurement and cranial nerve function is necessary.