Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: report of 28 cases

Giant Frontoethmoid Mucocele with Intracranial Extension: Case Report

We report the case of a 31-year-old woman who came to us with a giant frontoethmoid mass that had extended into the intracranial region and invaded the left orbit. We removed the lesion in its entirety via a combined intranasal and transcranial approach. We discuss the advantages and disadvantages of different surgical approaches, and we explain why we recommend a combined approach for the type of giant lesion that we encountered.

Single stage management of complex fronto-orbital mucoceles

Mucoceles arising in the frontal and/or ethmoid sinuses are clinically silent and often involve both the orbit and the anterior cranial fossa extensively. Five patients with advanced mucoceles of the frontal sinus involving the orbitocranial skeleton (OCM), as a result of recurrent sinusitis or trauma, were identified during a 36-month period in a major academic US institution. The range of pathology encountered involved brain herniations, CSF leaks, and extensive orbital involvement. These patients required major reconstructive efforts to restore proper orbital skeletal anatomy and function with the use of multiple calvarial bone grafts. The secondary effects of the pathologic process, such as orbital dystopia, ocular dysfunction, and CSF leak among others, resolved in all patients without further problems. Follow-up by repeat computed tomography and examination scan ranged from 6 weeks to 29 months. Adequate reconstruction of extensive OCMs involves four principles: 1) cranialization of the frontal sinus for adequate intracranial and orbital roof access; 2) complete removal of all mucosal elements from the frontal sinus, orbit, and dura; 3) precise restoration of orbital volume with calvarial bone grafts; and 4) reattachment of the medial canthal ligament to the bone grafts to avoid orbital dystopia. The results of the surgery are gratifying, but long-term follow-up is essential due to the risk of recurrence.

[Mucocele from concha bullosa with invasion of the orbit]

We present a case of a 44-year-old man that came to the clinic with exophthalmus and frontal headaches. TC and MRI showed a fronto-sphenoidal mass with extension to the cribiform plate involving the orbit and pushing the eyeball forward. The mass was completely excised through intranasal endoscopic surgery and it was found out to be a mucocele from concha bullosa.

Giant frontal mucocele extending into the anterior cranial fossa

The authors report a patient with a huge frontal mucocele presenting with transient left hemiparesis. Magnetic resonance imaging and computed tomography showed the huge frontal mucocele arising from the frontal sinus extending to the anterior cranial fo ssa. Right middle cerebral artery stenosis was seen on the carotid angiography. The mucocele was treated with Killian's surgery. On the postoperative seventh day, the patient showed massive cerebrospinal fluid leakage that ceased with conservative management. The patient was discharged from the hospital without any neurological deficit. We discuss the clinical symptoms and postoperative course of the huge frontal mucocele with intracranial extension.

Treatment of a sphenoid sinus mucocele using an endoscope combined with a navigating system: a case report

A sphenoid sinus mucocele extending into the middle cranial fossa and the pterygomaxillary fissure was decompressed using an endoscope in combination with a navigation system. A 59-year-old woman was admitted with a 3 month history of retro-ocular pain and right sided exophthalmos. To evaluate the cystic lesion, a fibreoptic endoscope was inserted into the cyst through an erosive defect in the temporal bone. The histopathological appearance of cyst wall tissue confirmed the diagnosis of mucocele. After 4 months, the mucocele had refilled and the exophthalmos had recurred. At reoperation, the cyst was fenestrated using a rigid endoscope combined with a navigation system inserted via a sublabial transmaxillary approach. The proper site of cyst fenestration was precisely determined using the navigation system, permitting complete evacuation of this large lesion with minimal invasiveness.

Extended transbasal approach with preservation of olfaction: ananatomical study

Many craniofacial approaches to the sphenoethmoidal region, anterior fossa, and central skull base compartment have been described, a number of which involve the mobilization of the frontonasoorbital complex en bloc. Spetzler's modification incorporates osteotomies around the cribriform plate, to preserve olfaction. In this morphological study of three cadavers, photographs were used to show the technique and define its anatomical boundaries and limitations. The study illustrates access to a number of anatomical regions, particularly the exposure of the medial orbit, the cavernous sinus, the clivus, and the vertebrobasilar complex.

Intracranial spread of a giant frontal mucocele: case report

A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltrated the dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the dura were resected. A 12 x 6cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bone graft from the right parietal region was used to repair the anterior frontal bony defect. The result one year later was satisfactory. Spiral computed tomography with thr ee-dimensional reconstructions excluded any recurrence of the tumour and showed good integration of bone grafts.

Intracranial mucocele as a complication of endoscopic repair of cerebrospinal fluid rhinorrhea: case report

OBJECTIVE AND IMPORTANCE

Endoscopic repair of an anterior cranial fossa cerebrospinal fluid (CSF) fistula has gained widespread acceptance. We report a case of mucocele development at the site of an endoscopic CSF leak repair.

CLINICAL PRESENTATION

A 46-year-old woman underwent functional endoscopic sinus surgery for nasal obstructive symptoms. The surgery was complicated by an intraoperative CSF leak from the posterior cribriform plate/anterior sphenoid, which was repaired immediately using bone and mucosa grafts. Two years postoperatively, a 13-mm anterior cranial base mass was found incidentally. This mass increased to 20 mm over the next year.

INTERVENTION

The anterior cranial base mass was excised via a right frontal craniotomy and confirmed histologically to be a mucocele.

CONCLUSION

Endoscopic repair of an anterior cranial base CSF fistula with mucosal grafts may lead to formation of a mucocele.

Mucocele of the anterior clinoid process: case report

OBJECTIVE AND IMPORTANCE

Of the primary intracranial mucoceles, those arising from the optic canal or anterior clinoid process are extremely rare. To our knowledge, only five cases have been reported. The pathogenesis of mucoceles at this unusual site is unclear, but the previously reported cases suggest that these mucoceles may originate from pneumatizing air cells in the anterior clinoid processes.

CLINICAL PRESENTATION

A 43-year-old woman presented with diplopia. Magnetic resonance imaging showed a small mass, compressing the optic nerve, in the medial portion of the left anterior clinoid process. The medial portion of the anterior clinoid process surrounding the mass was eroded and the bony margins of the mass were well corticated in computed tomographic scans. There was no direct connection between any paranasal sinus and the mass cavity, as assessed in imaging studies and intraoperatively confirmed. The pathological diagnosis after the operation indicated a mucocele.

CONCLUSION

Considering the absence of air cells in the anterior clinoid processes, the mucocele in this case might have originated from ectopic mucinous tissue that appeared during the development of the optic canal, rather than from a pneumatizing air cell.

Intradural extension of mucocele complicating frontoethmoid sinus osteoma: case report

BACKGROUND

Osteomas of the paranasal sinus are often asymptomatic and are sometimes complicated by mucoceles, but intradural extension of such a mucocele has rarely been reported.

CASE DESCRIPTION

This 67-year-old man with complaint of headache was diagnosed as having an intradural extension of a mucocele complicating an osteoma of the frontoethmoid sinus. A right frontobasal craniotomy was performed and a mucocele in the frontal sinus extending into the frontal lobe through two dural defects and the osteoma was removed completely. The patient was successfully treated without recurrence.

CONCLUSION

The importance of radical surgery for such lesions and the relationship between osteomas and mucoceles are discussed.

Intracranial mucoceles with midline fusion defects

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Life threatening intracranial complications of frontal sinus osteomas: report of two cases

Paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery. Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed.

Intracranial extension of paranasal sinus mucocele: two case reports

In two cases intracranial extension of mucoceles of the paranasal sinus was safely removed by intranasal evacuation and drainage of the lesions located in the paranasal sinus. The diagnosis was ascertained in both cases via intranasal approach. In addition, the volume of the intracranial lesions was reduced. This procedure is both effective and a less invasive diagnostic treatment for the lesion.

Giant intracranial mucocele

A 21-year-old man was admitted to hospital because of recent anosmia and liquorrhoea. He also complained of moderate headache and concentration problems in the past few years. On CT scan and MRI scans a big subfrontal process was seen, partially solid and partially cystic. Neurosurgical and histological findings proved that the lesion was an osteoma of the anterior skull base, concomitant with an intradurally extending mucocele.