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Background and Objectives The leakage of cerebrospinal fluid due to damage to the eth-moid roof and cribriform plate (CP) is one of the most serious complications of endoscopic si-nus surgery (ESS). For the risk of skull base injury during ESS, the Keros classification hasbeen widely used, but recently the Gera classification has been introduced as a tool for risk as-sessment. This study evaluated the risk of skull base damage using the Gera classification inKoreans. Subjects and Method We analyzed 592 left and right sides of 296 paranasal sinus CTs, andmeasure the angle between the lateral lamella of CP and the lateral extension of the horizontalplane passing through CP, namely the Gera angle. The angles were classified into three cate-gories: the type I (>80°, low risk), type II (45° to 80°, medium risk), and type III (<45°, high risk). Results The type III, which is vulnerable to skull base damage, accounted for 11.7% of thestudy subjects. The Gera angle in females (64.0°±12.3°) was greater than that in males (61.3°±14.0°), showing a significant gender difference ( p=0.015). Although there was no differencebetween the left and the right side of the Gera angle ( p=0.155), there was a significant differ-ence between the left and the right side in the Gera classification ( p<0.001). Age and the Geraangle showed a negative correlation (r=- 0.116 , p=0.005). Conclusion The type III of the Gera classification was observed in 11.7% of the total studygroup. For the type III, extra care is required during ESS.
