1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Rutledge WC, Ozair A, Villanueva-Meyer JE, Niehaus B, McDermott MW. "Open-window" craniectomy for the removal of frontal sinus mucosa to prevent a delayed mucocele: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23654. [PMID: 38408338 PMCID: PMC10901122 DOI: 10.3171/case23654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Frontal craniotomies for a medial subfrontal approach necessitate crossing the frontal sinus. Large superior extensions of the frontal sinus into frontal bone can result in mucosal retention in a free craniotomy bone flap, leading to a delayed mucocele with significant associated morbidity. The authors describe an "open-window" craniectomy technique that permits mucosal removal under direct vision and maintains the inner table on the bone flap's inferior side, helping to seal off the sinus opening with a pericranial flap. OBSERVATIONS An illustrative case involving a medial right frontal craniotomy for a third ventricle mass in a patient with a large superior extension of the frontal sinus into frontal bone is presented. After creating a free frontal bone flap, the inner table was drilled out to the margins of the frontal sinus cavity and any remaining mucosa was cleared. A portion of the inner table above the bone flap's inferior margin was left in place, resembling an open window when viewed from the inner table side. The remaining anterior and posterior wall of the flap inferiorly provided a matched surface for the opening into the remaining frontal sinus, which was covered by pericranium. Long-term follow-up indicated no major complications or delayed mucocele. LESSONS The open-window craniectomy technique can be considered for frontal sinus violations in patients with large superior frontal bone extension.
Collapse
Affiliation(s)
- W. Caleb Rutledge
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Ahmad Ozair
- Division of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; and
| | - Brian Niehaus
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Division of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
- Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Al-Shami H, Alnemare AK, Mahfoz TB, Salah AM. Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre. Korean J Neurotrauma 2021; 17:15-24. [PMID: 33981639 PMCID: PMC8093022 DOI: 10.13004/kjnt.2021.17.e3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. Methods Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010-2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. Results Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14-86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. Conclusion Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.
Collapse
Affiliation(s)
- Hieder Al-Shami
- Department of Neurosurgery, Al-Ahly Bank Hospital, Cairo, Egypt
| | - Ahmad K. Alnemare
- Department of Otolaryngology, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Turki Bin Mahfoz
- Department of Otolaryngology, Faculty of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Ahmed M. Salah
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo, Egypt
| |
Collapse
|
6
|
Is there still a role for cranialization in modern sinus surgery? Curr Opin Otolaryngol Head Neck Surg 2020; 29:53-58. [PMID: 33278134 DOI: 10.1097/moo.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses. RECENT FINDINGS Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options. SUMMARY Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.
Collapse
|
7
|
Indications and Outcomes of the Osteoplastic Flap Procedure With or Without Obliteration. J Craniofac Surg 2020; 31:2243-2249. [PMID: 33136864 DOI: 10.1097/scs.0000000000006717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the osteoplastic approach and to perform a systematic review of the indications and outcomes of the osteoplastic flap procedure for frontal sinus surgeries with or without obliteration. DATA SOURCES PubMed, Medline, Google Scholar, and Cochrane databases. REVIEW METHODS All published studies in the English language on the osteoplastic flap with or without obliteration were identified from 1905 to 2018. All studies with <20 patients were excluded. The number of patients, technique, indications, follow-up period, symptom relief, revision rates, and complications were recorded and analyzed. RESULTS A systematic review yielded 25 series containing 1374 patients for analysis. Indications for surgery included chronic frontal sinusitis, mucoceles, fractures or traumas, osteomas, neoplasms, and cerebrospinal fluid leak. The mean follow-up period ranged from 12.8 to 144 months. The percentage of patients needing revisions for frontal sinus disease was 6.2%. There was a high rate of symptomatic improvement (85.0%) and a low rate of major complications (0.7%). However, minor complications occurred in 19.4% of patients. CONCLUSION The osteoplastic flap with or without obliteration has many indications. In an era where endoscopic technique provides excellent access to the frontal sinuses, external approaches remain a useful adjunct, and/or salvage technique. In experienced hands, the osteoplastic flap can yield excellent long-term clinical results, with low rates of complications. Regardless of the surgical approach, long-term follow-up is necessary due to the recurrent nature of frontal sinus disease.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Peters DR, Payne C, Wait SD. Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus. J Neurol Surg B Skull Base 2020; 82:e190-e195. [PMID: 34306936 DOI: 10.1055/s-0039-3402025] [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: 04/15/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
Background The eyebrow orbitozygomatic craniotomy is a minimally invasive approach that can access a wide variety of lesions. Unintentional breach of the frontal sinus frequently occurs and has been cited as a reason to avoid this approach. Lack of access to a large pericranial graft and the inability to completely cranialize the sinus requires alternate techniques of sinus repair. We describe a technique for repairing an opened frontal sinus and retrospectively reviewed complications related to this approach. Methods All patients, who underwent an orbitozygomatic craniotomy via an eyebrow incision by a single surgeon from August 1, 2012 to August 31, 2018, were included in this retrospective analysis. Data were collected on patient demographics, pathology treated, operative details, and perioperative morbidity. Follow-up ranged from 6 weeks to 6 years. Results Total 50 patients with a wide variety of pathologies underwent analysis. Frontal sinus breach occurred in 21 patients. All were repaired by the described technique. One patient (ruptured aneurysm) had a suspected cerebrospinal fluid (CSF) leak postoperatively that resolved without any additional intervention. One patient developed a pneumomeningocele 4 years postoperatively that required reoperation. No patient suffered any infection or delayed CSF leak. Conclusion Breach of the frontal sinus is common during eyebrow craniotomies. Despite reduced options for local repair, these patients have experienced no CSF leaks requiring intervention and no infections in our series. Long-term mucocele risk is not reliably determined with our length of follow-up. Breach of the frontal sinus is not a contraindication to the eyebrow approach.
Collapse
Affiliation(s)
- David R Peters
- Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina, United States.,Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, United States
| | - Caitlin Payne
- Department of Neurosurgery, Dartmouth-Hitchcock, Hanover, New Hampshire, United States
| | - Scott D Wait
- Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina, United States.,Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, United States.,Department of Pediatric Neurosurgery, Levine Children's Hospital, Charlotte, North Carolina, United States
| |
Collapse
|
11
|
Farag A, Rosen MR, Ziegler N, Rimmer RA, Evans JJ, Farrell CJ, Nyquist GG. Management and Surveillance of Frontal Sinus Violation following Craniotomy. J Neurol Surg B Skull Base 2019; 81:1-7. [PMID: 32021743 DOI: 10.1055/s-0038-1676826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives In the setting of craniotomy, complications after traversing the frontal sinus can lead to mucocele formation and frontal sinusitis. We review the etiology of frontal sinus violation, timeline to mucocele development, intraoperative management of the violated sinus, and treatment of frontal mucoceles. Design Case series in conjunction with a literature review. Participants A total of 35 patients were included in this meta-analysis. Nine of these patients were treated at a tertiary academic medical center between 2005 and 2014. The remaining patients were identified through a literature review for which 2,763 articles were identified, of which 4 articles met inclusion criteria. Main Outcomes Measures Etiology of frontal violation, timeline to mucocele development, and method of management. Results The overall interval from initial frontal sinus violation until mucocele identification was 14.5 years, with a range of 3 months to 36 years. The most common cause of mucocele formation was obstruction of the frontal recess with incomplete removal of the frontal sinus mucosa. The majority of patients were successfully managed with an endoscopic endonasal approach. Conclusions Violation of the frontal sinus during craniotomy can result in mucocele formation as an early or late sequela. Image guidance may help avoid unnecessary frontal sinus violation. Mucoceles may develop decades after the initial frontal sinus violation, and long-term follow-up with imaging is recommended. While the endoscopic endonasal approach is usually the preferred method to treat these lesions, it may be necessary to perform obliteration or cranialization in unique situations.
Collapse
Affiliation(s)
- Alexander Farag
- Department of Otolaryngology, The Ohio State University, Columbus, Ohio, United States
| | - Marc R Rosen
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Natalie Ziegler
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Ryan A Rimmer
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - James J Evans
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Christopher J Farrell
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gurston G Nyquist
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| |
Collapse
|
12
|
Abstract
The aim of the study was to correlate several studies dating from 1997 to 2015 to identify the most effective treatments for mucocele in the frontal sinus (with/without other paranasal sinuses), considering successful outcomes and recurrence. We aimed to conduct a literature review for articles published between 1997 and 2015. For this, we accessed articles in the SciELO database, as well as LILACS, PubMed, and Google Scholar databases. Were identified 32 work-related injuries in the paranasal sinuses; 2 of these were not related to mucoceles or mucopyocele, 4 had no relation to the frontal sinus, 9 were related to the frontal sinus and other paranasal sinuses, 4 were related to mucocele associated with other sinuses, and 13 involved only the frontal sinus. Endoscopic techniques decrease intra- and postoperative morbidity, reducing the operative time, allow a larger view of the lesion and surrounding anatomical structures, and decrease chances of recurrence. Thus, the successful outcomes have been beneficial to both the surgeon and the patient.
Collapse
|
13
|
Kim YW, Lee DH, Cheon YW. Secondary Reconstruction of Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:103-110. [PMID: 28913266 PMCID: PMC5556797 DOI: 10.7181/acfs.2016.17.3.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022] Open
Abstract
Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
Collapse
Affiliation(s)
- Yang Woo Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| |
Collapse
|
14
|
Foy JP, Khonsari RH, Bertolus C, Espitalier F, Ferron C, Corre P, Faure A. 'Canalization' of the frontal sinus: a functional approach for the management of post-traumatic sinusitis with lateral bony septa. Report of two cases and long-term follow-up. Int J Oral Maxillofac Surg 2016; 45:884-6. [PMID: 26922495 DOI: 10.1016/j.ijom.2016.01.014] [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: 05/24/2015] [Revised: 12/11/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
The patency of the naso-frontal duct is a key issue in the surgical management of chronic frontal sinusitis. Most of the current operative techniques only provide access to the paramedian portions of the frontal sinus. A canalization approach that allows a functional frontal sinus to be maintained while providing good access to the most lateral areas of the sinus is described herein. Two cases of severe post-traumatic frontal sinusitis, operated on successfully by canalization method based on the conservation of the frontal sinus and the maintenance of the patency of the naso-frontal duct, using both open and endonasal approaches, are reported. One patient was followed-up for 8 years and the other for 7 months. Canalization requires validation in a larger series. This approach provides an alternative to both cranialization and strictly endoscopic methods in lateralized frontal sinus retentions and allows mucocele to be avoided.
Collapse
Affiliation(s)
- J-P Foy
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - R H Khonsari
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France.
| | - C Bertolus
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - F Espitalier
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - C Ferron
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - P Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes, France
| | - A Faure
- Service de Neurotraumatologie, CHU Nantes, Nantes, France
| |
Collapse
|
15
|
Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
Collapse
Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
| |
Collapse
|
16
|
An Effective Method of Frontal Sinus Reconstruction After Bifrontal Craniotomy: Experience with 103 Patients. World Neurosurg 2015; 83:907-11. [PMID: 25659805 DOI: 10.1016/j.wneu.2015.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bifrontal craniotomy is effective for the treatment of anterior skull base lesions. However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid leakage and infection. We describe our procedure for maintaining the patency of the nasofrontal duct and direct suture of the exposed and violated FS mucosa. METHODS Bifrontal craniotomy with reconstruction of the FS was performed in 103 patients (68 women and 35 men; age range, 32-90 years; mean age, 62.6 years) for lesions including anterior cerebral artery aneurysm (100 cases), arteriovenous fistula (1 case), and meningioma (2 cases). After opening the FS, the mucosal membrane of the FS was dissected from the FS wall, and the orifice of the FS mucosa was closed with 7-0 monofilament running sutures. The nasofrontal duct was kept open by washing thoroughly to remove any bone dust and clot in the FS. The cavity of the FS was then packed with abdominal fat. RESULTS Postoperative cerebrospinal fluid leakage and mucocele formation did not occur in any patient. An intracranial infectious complication occurred in 1 patient (1.0%). CONCLUSIONS The present results indicate the effectiveness of our technique for the prevention of FS-related postoperative complications.
Collapse
|