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Ariyaprakai C, Akharathammachote N, Chonhenchob A, Sriamornrattanakul K. Frontal sinus reconstruction with overlapping sinus mucosa and vascularized pericranial flap Coverage after modified transbasal bifrontal craniotomy: Novel technique and clinical outcomes. World Neurosurg X 2024; 23:100389. [PMID: 38756755 PMCID: PMC11097086 DOI: 10.1016/j.wnsx.2024.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
Background The modified transbasal bifrontal craniotomy is a variant of the bifrontal craniotomy with a wider surgical corridor than the standard approach. There are several methods for frontal sinus repair in bifrontal craniotomy. This study reports a novel method for frontal sinus repair in the modified transbasal interhemispheric approach by precisely overlapping the frontal sinus mucosa margin (without frontal sinus mucosa exenteration) with packing the frontal sinus with povidone-soaked gel foam and covering it with a vascularized pericranial flap. Methods In this case series, we retrospectively collected the clinical outcomes regarding cerebrospinal fluid (CSF) leakage, meningitis, and mucocele formation of patients who underwent modified transbasal bifrontal craniotomy at Vara Hospital. Results From January 2016 to December 2021, 65 patients with anterior skull-base lesions were treated with a modified transbasal interhemispheric approach with frontal sinus repair by overlapping frontal sinus mucosa with gel foam packing and vascularized pericranium flap covering. There was no case of postoperative CSF leakage, meningitis, or mucocele formation during the follow-up period of 19.2 months (min 1, max 73). Conclusions We demonstrated that the modified transbasal interhemispheric approach with frontal sinus repair using gel foam packing and pericranial flap is effective in preventing postoperative CSF leakage and meningitis.
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Affiliation(s)
- Chanon Ariyaprakai
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nasaeng Akharathammachote
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Areeporn Chonhenchob
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kitiporn Sriamornrattanakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Liu X, Zhang F, Qiu Y, Yin Y, Lv X, Gao M, Shen H, Liu L. Reconstruction of the Large Frontal Sinus Defect With the Small Supporting Bone Pieces in Neurosurgical Anterior Skull Base Surgery. World Neurosurg 2024; 186:e125-e133. [PMID: 38521218 DOI: 10.1016/j.wneu.2024.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully. METHODS Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected. RESULTS Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications. CONCLUSIONS Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.
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Affiliation(s)
- Xi Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yankai Qiu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yibo Yin
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xing Lv
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mengyu Gao
- Department of Cardiology, Fourth Hospital of Harbin, Harbin, China
| | - Hong Shen
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Sato H, Ooigawa H, Suzuki K, Yanagawa T, Lepic M, Otsuka M, Fushihara G, Kurita H. Frontal Sinus Mucosa Bacteriological Features: Evaluation after Unintentional Opening in Neurosurgery. J Neurol Surg B Skull Base 2024; 85:119-122. [PMID: 38449577 PMCID: PMC10914460 DOI: 10.1055/a-2015-8371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives The bacteriological features of the frontal sinus mucosa may impose significant complications in neurosurgery, when breached unintentionally. This study aimed to investigate the bacterial flora in patients undergoing frontal craniotomy for cerebrovascular substrate surgery. Design This is a single-center prospective study. Setting When mucosal laceration occurred, the patients underwent frontal sinus reconstruction with mucosa reconstruction, preserving the nasofrontal duct. Participants We enrolled eight consecutive patients who underwent bifrontal craniotomy associated with frontal sinus mucosa laceration. Main Outcome Measures A portion of the mucosa was extracted during the reconstructive procedure and was sent for microbiological analysis. Results None of the patients presented with the bacterial flora in the mucosal cultures. No patient experienced postoperative cerebrospinal fluid leakage or meningitis. One patient with a clinical history of chronic maxillary sinusitis presented with a subcutaneous abscess around the forehead at 9 months postoperatively. The patient rapidly recovered after receiving oral administration of antibiotics. Conclusions Our findings demonstrated that the frontal sinuses were maintained in an aseptic environment in all cases. The results may encourage the development and wider use of transfrontal sinus approaches.
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Affiliation(s)
- Hiroki Sato
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Hidetoshi Ooigawa
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kaima Suzuki
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Taro Yanagawa
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
| | - Milan Lepic
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Munehiro Otsuka
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
| | - Goji Fushihara
- Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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Takahara M, Murakami T, Toyota S, Okuhara S, Touhara K, Hoshikuma Y, Yamada S, Achiha T, Kobayashi M, Kishima H. The Usefulness of Surgical Titanium Microclips for Mucosal Repair in the Frontal Sinus Using ORBEYE: A Technical Note. Neurol Med Chir (Tokyo) 2024; 64:131-135. [PMID: 38296551 PMCID: PMC10992985 DOI: 10.2176/jns-nmc.2023-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 03/19/2024] Open
Abstract
Bifrontal craniotomy frequently involves opening the frontal sinus and mucosal injury. We report a new technique for mucosal repair in the frontal sinus using surgical titanium microclips. Six consecutive patients who underwent bifrontal craniotomy with frontal sinus exposure and mucosal injury underwent mucosal repair using surgical titanium microclips between April 2019 and August 2022. In all cases, the frontal sinus mucosa was peeled from the inner walls of the frontal sinus to ensure sufficient mucosal margin for clipping using ORBEYE. The repair was accomplished with the microclips in all cases. We also sealed the mucosal wound using fibrin glue and sufficiently filled the frontal sinus with bone debris, resulting in zero incidence of postoperative liquorrhea in all cases. Repairing the mucosa using surgical titanium microclips using ORBEYE may be a simple and quick technique when the frontal sinus mucosa is injured during craniotomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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Kodera T, Isozaki M, Akazawa A, Oiwa M, Yamauchi T, Yamada S, Tai K, Kawajiri S, Kidoguchi M, Higashino Y, Hashimoto N, Arishima H, Iino S, Kikuta KI. Anatomy of the Frontal Sinus Drainage Pathway Evaluated in 247 Cadavers to Prevent Cerebrospinal Fluid Leakage After Frontobasal Craniotomy. Oper Neurosurg (Hagerstown) 2024; 26:54-63. [PMID: 37747348 DOI: 10.1227/ons.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The frontal sinus (FS) drainage pathway (FSDP) may be a conduit for cerebrospinal fluid leakage after frontobasal craniotomy. In this cadaveric study, we aimed to evaluate the anatomy of the FSDP. METHODS The FSs and FSDPs of 247 cadavers were investigated. We counted the number of FSs and FSDPs in each half-head, verified the presence of a narrowing section in each FSDP, and evaluated the depth, shape, and size of each narrowing FSDP section. RESULTS We investigated 494 sides and 472 FSDPs of 247 cadavers. FSs were unilaterally undeveloped in 13 of 247 cadavers (5.3%) and bilaterally in 8 (3.2%). FSs were unilaterally duplicated in 7 of 247 cadavers (2.8%), and no FSs were bilaterally duplicated or triplicated. No FSs had 2 or more FSDPs, and all 472 investigated FSDPs were invariably narrowed at various depths. The narrowing FSDP sections were elliptical (78.6%), circular (18.1%), triangular (1.8%), or crescent-shaped (1.4%) and of varying thickness and orientation. Although FSDPs were asymmetric in 92.2% of cadavers and narrowing FSDP sections were located deep (8.9 ± 4.4 mm from the anterior skull base), the narrowing FSDP sections were typically small (area: 5.9 ± 3.3 mm 2 ) or thin (short diameter: 2.1 ± 0.7 mm). CONCLUSION Each FS had only one FSDP, all FSDPs were invariably narrowed at various depths, and the narrowing FSDP sections were sufficiently small or thin to allow local closure, facilitating prevention of cerebrospinal fluid leakage after frontobasal craniotomy.
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Affiliation(s)
- Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
- Fukui Prefectural Hospital, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Mizuki Oiwa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Shintaro Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Katsuhide Tai
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Norichika Hashimoto
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Hidetaka Arishima
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Satoshi Iino
- Department of Anatomy, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
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Guo Y, Fu X, Yin W, Jiang Z, Kuang Y, Wu Z, Cao Y, Tan J, Jiang XJ. A practical and economical method for frontal sinus reconstruction after frontal craniotomy: A single-center experience with 140 patients. Front Surg 2022; 9:919276. [PMID: 35937594 PMCID: PMC9346075 DOI: 10.3389/fsurg.2022.919276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Frontal sinus exposure is a common consequence of frontal craniotomy. Cerebrospinal fluid leakage and infection are the major postoperative complications that may occur as a result of the open frontal sinus. The successful filling of the open frontal sinus provides an approach to prevent significant complications caused by frontal sinus exposure. Objective This article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap. Methods A total of 140 patients underwent frontal sinus reconstruction using gelfoam and vascularized pericranial flaps from 2016 to 2021. Gelatin sponge was used to fill the frontal sinus, and a vascularized pericranial flap was used to cover the frontal sinus when the bone flap was retracted. Results Postoperative cerebrospinal fluid leakage and infection did not occur in any patient. Conclusion Our results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications.
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Affiliation(s)
- Youwei Guo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xianyong Fu
- Department of Neurosurgery, Hospital of the Chinese People’s Liberation Army, Third Military Medical University, Chongqing, China
| | - Wen Yin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yirui Kuang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoping Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yudong Cao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Tan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
| | - Xing-jun Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
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Ortiz Torres M, Ziu E, Agunbiade S, Carr SB, Litofsky NS. Bifrontal Osteoplastic Flap: An Option to Decrease Infection in Bifrontal Craniotomies with Skull Base Osteotomies. Brain Sci 2022; 12:brainsci12020163. [PMID: 35203925 PMCID: PMC8870631 DOI: 10.3390/brainsci12020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Infection can be a common complication following bifrontal craniotomy with skull base osteotomies given the potential violation of sinuses and entry into the nasal structures. Our objective was to examine our series of patients who underwent a bifrontal craniotomy with skull base osteotomies and describe the infection rate. We propose the bifrontal osteoplastic flap as an adjunct to infection prevention. A retrospective single-center study of a patient database was performed. Twenty patients were identified. Fifty-five percent were male. The mean age was 55.7 ± 13.9 years. The most common indications for surgery were esthesioneuroblastomas (35%) and anterior skull base meningiomas (30%). Six patients (30%) developed an infection, 1 patient (5%) developed a CSF leak, and no patients developed a mucocele. All 6 infected cases had nasal pathology with intracranial extension, they all received chemoradiation post-operatively and were all combined cases with otorhinolaryngology. Eighty-three percent of these patients required a craniectomy and all of them required long-term IV antibiotics. Infection is not uncommon after a bifrontal craniotomy with skull base osteotomies and the use of the bifrontal osteoplastic flap in cases where the risk of infection is high, i.e., esthesioneuroblastomas surgery, may help reduce said risk and lead to better patient outcomes.
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Crocetta FM, Farneti P, Sollini G, Castellucci A, Ghidini A, Spinosi MC, Fernandez IJ, Zoli M, Mazzatenta D, Pasquini E. Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature. Eur Arch Otorhinolaryngol 2020; 278:1035-1045. [PMID: 32880737 DOI: 10.1007/s00405-020-06335-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. RESULTS In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. CONCLUSION Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation.
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Affiliation(s)
- F M Crocetta
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. .,ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - P Farneti
- ENT Department, Santa Maria Della Scaletta Hospital, Imola, BO, Italy
| | - G Sollini
- ENT Department, Bellaria Hospital, Bologna, Italy
| | - A Castellucci
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - A Ghidini
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - M C Spinosi
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - I J Fernandez
- ENT Department, University Hospital of Modena, Modena, Italy
| | - M Zoli
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - D Mazzatenta
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - E Pasquini
- ENT Department, Bellaria Hospital, Bologna, Italy
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Yu P, Mao X, Li X, Hu X, Li J, Sun G. Endoscopic frontal trephination verse the osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy. Br J Neurosurg 2020; 35:65-67. [PMID: 32351138 DOI: 10.1080/02688697.2020.1759781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We review the clinical outcome of endoscopic frontal trephination and osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy. METHODS The clinical data of patients with frontal sinus disease after bifrontal craniotomy between 2008 and 2018 were studied. RESULTS Twenty-two patients underwent trephination and 15 patients had osteoplastic flap. The mean operation time was 101.5 min for osteoplactic flap, statistically shorter than that of the trephination (p < 0.05). The blood loss during the trephination was significantly lower than that of the osteoplactis flap (mean, 29.6 ± 11.5 versus 96.3 ± 46.8 ml; p < 0.01). The postoperative hospital stay was 2.2 ± 0.7 days for patients of the trephination and 3.7 ± 1.6 days for patients of the osteoplastic flap, and this difference was statistically significant (p < 0.01). No complication and recurrence in all 37 patients. CONCLUSIONS Both endoscopic frontal trephination and the osteoplastic flap are safe and highly effective in patients with frontal sinus disease after bifrontal craniotomy. However, the trephination can cause lower blood loss and require shorter postoperative stay while it takes shorter time to complete the osteoplactis flap.
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Affiliation(s)
- Pengcheng Yu
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xiaomeng Mao
- Department of Nursing, Huashan Hospital of Fudan University, Shanghai, China
| | - Xumao Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xinqi Hu
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Jiaying Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
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Wongsuriyanan S, Sriamornrattanakul K. Interhemispheric Approach with Early A1 Exposure for Clipping Anterior Communicating Artery Aneurysms: Operative Techniques and Outcomes. World Neurosurg 2020; 138:e579-e590. [PMID: 32165343 DOI: 10.1016/j.wneu.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The interhemispheric approach (IHA) provides an excellent surgical corridor for clipping anterior communicating artery aneurysms (AcoAAs). However, an important disadvantage of the approach is obtaining proximal control at A1 in the last stage of dissection, especially in anterior or superior projecting AcoAAs and ruptured cases. We describe and evaluate the microsurgical clipping of AcoAAs using the IHA with early A1 exposure. METHODS This was a retrospective descriptive study in patients with AcoAA who received microsurgical clipping through the IHA with early A1 exposure between April 2016 and May 2019. Aneurysm morphology, projection, completeness of clipping, surgical complications, and outcomes were collected from medical records. RESULTS Twenty-five patients with AcoAA received microsurgical clipping via the IHA with early A1 exposure. Twenty-three patients (92%) presented with subarachnoid hemorrhage. Intraoperative rupture while dissecting the interhemispheric fissure occurred in 2 cases, for which proximal control via subfrontal route was effectively performed. Of the patients, 100% achieved complete obliteration of their aneurysms. Postoperative anosmia was detected in 22.7%. In ruptured cases, 16 (88.9%) of the good grade patients achieved a good outcome (Glasgow Outcome Scale scores of 4 and 5) at 3 months after the operation. CONCLUSIONS The IHA with early A1 is safe and effective for clipping AcoAAs.
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Affiliation(s)
- Somkiat Wongsuriyanan
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kitiporn Sriamornrattanakul
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
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11
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Matsuura J, Otsuka T, Nakagawa T, Kai K. Frontal Sinus Repair Using Polymethyl Methacrylate After Bifrontal Craniotomy. World Neurosurg 2018; 124:S1878-8750(18)32906-1. [PMID: 30593968 DOI: 10.1016/j.wneu.2018.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In many cases in which bifrontal craniotomy is performed, the frontal sinus is opened, and postoperative complications occur. Various methods to close the frontal sinus have been reported. However, all these methods require skill to perform and take time. The aim of this study was to report results obtained with closure of the frontal sinus using polymethyl methacrylate, which is a simpler method. METHODS From December 2008 to June 2018, 122 patients with a ruptured anterior communicating aneurysm were transported to the authors' facility, and 52 patients consecutively underwent bifrontal craniotomy with opening of the frontal sinuses, which were then filled with polymethyl methacrylate. RESULTS Mean follow-up period was 21.8 months; the longest follow-up was 116 months. No cerebrospinal fluid leakage or other complications were observed. CONCLUSIONS The method of filling the frontal sinus with polymethyl methacrylate reported in this study was safe and had no complications. This method should be considered as a method of frontal sinus closure.
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Affiliation(s)
- Jin Matsuura
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
| | - Tadahiro Otsuka
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takashi Nakagawa
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Keitaro Kai
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
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Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal Sinus Breach During Routine Frontal Craniotomy Significantly Increases Risk of Surgical Site Infection: 10-Year Retrospective Analysis. Neurosurgery 2018; 81:504-511. [PMID: 28327980 DOI: 10.1093/neuros/nyx046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frontotemporal craniotomies are commonly performed for a variety of neurosurgical pathologies. Infections related to craniotomies cause significant morbidity. We hypothesized that the risk of cranial surgical site infections (SSIs) may be increased in patients whose frontal sinuses are breached during craniotomy. OBJECTIVE To compare the rate of cranial SSIs in patients undergoing frontotemporal craniotomies with and without frontal sinus breach (FSB). METHODS We performed a retrospective analysis of all patients undergoing frontotemporal craniotomies for the management of cerebral aneurysms from 2005 to 2014. This study included 862 patients undergoing 910 craniotomies. Primary outcome of interest was occurrence of a cranial SSI. Standard statistical methods were utilized to explore associations between a variety of variables including FSB, cranial SSI, and infections requiring reoperation. RESULTS Of the 910 craniotomies, 141 (15.5%) involved FSB. Of those involving FSB, 22 (15.6%) developed a cranial SSI, compared to only 56 of the 769 without FSB (7.3%; P = .001). Cranial SSI requiring reoperation was much more likely in patients with FSB compared to those without a breach (7.8% vs 1.6%; P < .001). In those presenting with cranial SSIs, epidural abscess formation was more common with FSB compared to no FSB (27.3% vs 5.4%; P = .006). In multivariate analysis, breach of the frontal sinus was significantly associated with cranial SSI (OR 2.16; 95% CI 1.24-3.78; P = .01) and reoperation (OR 4.20; 95% CI 1.66-10.65; P = .003). CONCLUSION Patients undergoing frontotemporal craniotomies are at significantly greater risk of serious cranial SSIs if the frontal sinus has been breached.
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Affiliation(s)
| | - Thomas J Wilson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Franco-Jiménez J, Ceja-Espinosa A, Huato-Reyes R, Tevera-Ovando C, Ruiz-Flores M. Craniofacial reconstruction with cryopreserved autograft. Case report and technique description. ORAL AND MAXILLOFACIAL SURGERY CASES 2018. [DOI: 10.1016/j.omsc.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sakarunchai I, Tanikawa R, Ota N, Noda K, Matsukawa H, Kamiyama H. Toward a more rationalized use of a special technique for repair of frontal air sinus after cerebral aneurysm surgery: The most effective technique. INTERDISCIPLINARY NEUROSURGERY 2016. [DOI: 10.1016/j.inat.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ravindra VM, Neil JA, Shah LM, Schmidt RH, Bisson EF. Surgical management of traumatic frontal sinus fractures: Case series from a single institution and literature review. Surg Neurol Int 2015; 6:141. [PMID: 26392917 PMCID: PMC4553660 DOI: 10.4103/2152-7806.163449] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/07/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neurosurgeons are frequently involved in the management of patients with traumatic frontal sinus injury; however, management options and operative techniques can vary significantly. In this study, the authors review the current literature and retrospectively review the clinical series at a single tertiary referral center. METHODS After Institutional Review Board approval, the medical records and computed tomographic (CT) imaging of patients whose traumatic frontal sinus fractures were treated surgically at the University of Utah were retrospectively reviewed. Demographic information, mechanism of injury, associated injuries, operative technique, and pattern of injury on CT were analyzed. RESULTS Between 2000 and 2012, 33 patients underwent successful cranialization of the frontal sinus following traumatic injury. The material used to obliterate the sinus varied. No patients required immediate or delayed reoperation. Nasofrontal outflow tract obstruction, the importance of which has been emphasized in the plastic surgery literature, was apparent on either initial or retrospective review of the available CT imaging in 96%. CONCLUSIONS In this series, we successfully surgically treated 33 patients with frontal sinus fractures. The presence of cerebrospinal fluid leak, nasofrontal outflow tract injury, associated depressed skull fractures, and subsequent formation of communicating pathways and infection must be considered when constructing a treatment plan. The goals of treatment should be: (i) surgical repair of the defect and elimination of the conduit from the intracranial space to the outside and (ii) elimination of any cerebrospinal fluid pressure gradient that may develop across the surgical repair. We present a treatment algorithm focusing on the presence of nasofrontal outflow tract injury/obstruction, cosmetic deformity, and cerebrospinal fluid leak.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Jayson A Neil
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Lubdha M Shah
- Department of Radiology, University of Utah, 30 North 1900 East, Salt Lake City, Utah, 84132, USA
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
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