Bilateral Versus Unilateral Cranialization in the Management of a Breached Frontal Sinus

Abstract

Background: Frontal sinus breach during craniotomy may occur inadvertently or intentionally. Management of a breached frontal sinus is controversial as numerous operative techniques have been described. Frontal sinus breach may result in life-threatening complications, require additional surgeries, and increase the risk for long-term infectious sequelae. A literature review found a paucity of neurosurgical reports examining breached frontal sinus management or specific analyses of unilateral versus bilateral frontal sinus cranialization. Objective: A frontal sinus cranialization technique employed for patients involving frontal sinus breach and analyze outcomes managed with bilateral versus unilateral cranialization was presented in this study. Methods: A retrospective review of outcomes was performed using our Institutional Review Board-approved surgical case database between September 2012 and September 2018. Results: Thirty-three frontal sinus cranializations following frontal sinus breach were identified. Average follow-up time was 25 months. A statistically significant difference in postoperative infections was observed in patients with a history of previous cranial surgery who underwent unilateral compared to bilateral frontal sinus cranialization. Conclusion: These results suggest surgeons performing craniotomy or consulted intraoperatively for suspected frontal sinus breach should have a high suspicion for breached frontal sinus and a low threshold for frontal sinus cranialization. Furthermore, when performing frontal sinus cranialization, surgeons should consider performing bilateral, instead of unilateral, cranialization in patients with a history of previous craniotomy as bilateral cranialization was shown to decrease the risk of postoperative infection.

Surgical Implications and Radiologic Classification for the Upward Bulging of the Planum Sphenoidale in Patients With Anterior Skull Base Meningiomas Involving the Tuberculum Sellae Area

“…During the operation, the surgeons required a larger surgical perspective to accomplish devascularization and detachment of the tumor behind the upward bulging of the PS, which causes a complex operation, resulting in a lower rate of GTR. Sometimes, to reduce the tumor blind area, it is necessary to remove a portion of the upward bulging bone, but this increases the risk of CSF (Cerebrospinal fluid) leakage and paranasal sinus breach could lead to a life-threatening infection 13. We use a high-speed drill to partially or completely grind the anterior base of the skull according to intraoperative needs.…”

“…Sometimes, to reduce the tumor blind area, it is necessary to remove a portion of the upward bulging bone, but this increases the risk of CSF (Cerebrospinal fluid) leakage and paranasal sinus breach could lead to a life-threatening infection. 13 We use a high-speed drill to partially or completely grind the anterior base of the skull according to intraoperative needs. When the skull base was completely injured, we used abdominal fat or temporalis muscle and frontal fascia to create a multilayer covering for the breach, and glue was used to seal the edges.…”

Foramen Caecum Vein Involved in Dural Arteriovenous Fistula Fed by Sphenopalatine Arteries: A Case Report

“…We performed, in accordance with a recent review of literature, 22) a small unilateral high frontal craniotomy, with the advantages of less destructive bone work, frontal sinus sparing and less brain retraction; on the same time, the CSF diversion allows a dynamic brain retraction that reduces the risk of unintentional dural opening and the possible superficial veins breaking during craniotomy. 23 , 24) …”

The Role of Endonasal Endoscopic Skull Base Repair in Posttraumatic Tension Pneumocephalus

“…If there is a high suspicion for a breached frontal sinus, the surgeon should have a low threshold for frontal sinus cranialization, because of its inherent risk for postoperative infectious complications, additional surgeries, and further hospitalizations. 34 Generally, bilateral cranialization of the frontal sinuses may be necessary to repair all possible skull base defects. Belzberg et al 34 reported a higher risk of surgical sinus and surgical site infections in TCA with unilateral cranialization of frontal sinus instead of bilateral cranialization for frontal sinus breach in patient with history of previous craniotomy.…”

“…The anterior skull base is hereby exposed via a bifrontal craniotomy lining anteriorly along the orbital ridges and laterally along the temporal fossa. If there is a high suspicion for a breached frontal sinus, the surgeon should have a low threshold for frontal sinus cranialization, because of its inherent risk for postoperative infectious complications, additional surgeries, and further hospitalizations 34 . Generally, bilateral cranialization of the frontal sinuses may be necessary to repair all possible skull base defects.…”