Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

Abstract

Summary Introduction: The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses. Aim: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques. Method: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure. Discussion: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months. Conclusion: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective.

The sinus septi nasi and other minor pneumatizations of the nasal septum

“…Nevertheless, a different study assessed the origin of the CG pneumatization as either frontal, or ethmoidal [12]. The incidence of such air space of the CG was evaluated in different studies (Table 1) and it seemingly depends on the population which is studied [13]. Before Mladina et al study [1], Lei et al performed a study in 32 patients to investigate the occurrence rate of pneumatization of the PPE and found the PPE pneumatization in six cases, thus in 18.75% [23].…”

“…Nevertheless, a different study assessed the origin of the CG pneumatization as either frontal, or ethmoidal [ 12 ]. The incidence of such air space of the CG was evaluated in different studies (Table 1 ) and it seemingly depends on the population which is studied [ 13 ].…”

Crista galli sinusitis – a radiological impression or a real clinical entity

“…In case of ostial blockage, an inflammatory -infectious response, similar to a regular rhinosinusitis, can occur. Socher et al 7 reported 3 clinical cases in which chronic headache were attributed to the inflammatory process within the pneumatized crista galli. They succeeded to endoscopically remove the inflammatory changed mucosa within the pneumatized crista galli and the outcomes in all three patients have been excellent!…”

“…The reported incidence of pneumatized crista galli varies a lot according to different authors, from 3-37.5% [3][4][5][6] . There are several theories explaining the pneumatization of crista galli, but the most widely accepted are two: the first that advocates pneumatization from the ethmoid sinus and another one that advocates crista galli pneumatization from the frontal sinus 7 . The communication between the pneumatized crista galli and the adjacent paranasal structures usually happens through an opening similar to other sinus ostia, opened in most of the cases in the frontal sinus cavity 6 .…”

“…76.2%), in contrast with 60.5% for the patients with CRS but with no opacification of the pneumatized crista galli, may lead to the conclusion that crista galli sinusitis is a real clinical entity, and a more frequent reason for chronic headache than CRS alone. Socher et al 7 described 3 clinical cases of crista galli sinusitis, emphasizing that medical antibiotic treatment had little to no effect on crista galli inflammation. The crista galli pneumatization was successfully accessed through the trans-septal endoscopic approach, with the positive effect regarding the cessation of the headache.…”