Cerebrospinal fluid fistula prevention and treatment following frontal sinus fractures: a review of initial management and outcomes

Castro, Brandyn; Walcott, Brian P.; Redjal, Navid; Coumans, Jean-Valéry; Nahed, Brian V.

doi:10.3171/2012.3.focus1266

Cited by 12 publications

(3 citation statements)

References 30 publications

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“…8,14 Over the last three decades, the literature regarding frontal sinus fractures has focused on treatment methods based on the type of fracture. 5,6,13,[15][16][17][18] There are two major series that outline treatment algorithms: Rodriguez and Bell. 5,6,19 The Bell algorithm evaluates each fracture based first on displacement, then nasofrontal duct injury, and finally posterior table injury.…”

Section: Discussionmentioning

confidence: 99%

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Miller

Weisbrod

Beahm

et al. 2019

J Neurol Surg B Skull Base

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Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional breach of the frontal sinus. These techniques, however, result in the loss of frontal sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele. Compartmentalization is an open technique for repair of the frontal sinus using allograft onlay and a vascularized periosteal flap that allows for preservation of frontal sinus function. Objective The main objective of this article is to describe the technique for compartmentalization of the frontal sinus and demonstrate its efficacy and complication rate with an early patient series. Methods Our technique includes the following key components: harvesting of a pedicled periosteal flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal, ensuring the patency of the nasal frontal outflow tract, and separation of the brain from the frontal sinus with a dual layer of periosteum and allograft.All cases of frontal sinus repair using the compartmentalization technique at our institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other complications. Results Twenty-three patients underwent the described frontal sinus repair technique 17 for tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced postoperative anemia and a “parameningeal reaction” that were managed with a short course of antibiotics. Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents a meaningful step forward in neurosurgical technique for open frontal sinus repair. However, long-term outcomes are necessary to fully evaluate risk of mucocele.

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Section: Discussionmentioning

confidence: 99%

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Miller

Weisbrod

Beahm

et al. 2019

J Neurol Surg B Skull Base

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“…After frontal sinus injury, the frontal sinus can drains through venules known as the foramina of Breschet into the dural veins, allowing for intracranial spread of pathogens. Debate surrounds the use of prophylactic antibiotics, especially beyond the perioperative period with a large meta-analysis failing to show a significant decrease in the risk of meningitis and any other infectious complication [ 29 30 ]. Such data must be weighted against the risk of severe opportunistic infections and selecting for resistant flora.…”

Section: Secondary Treatment Of Complications After Frontal Sinus Framentioning

confidence: 99%

Secondary Reconstruction of Frontal Sinus Fracture

Kim¹,

Lee²,

Cheon³

2016

Arch Craniofac Surg

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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.

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“…Therefore, surgical repair (frontal sinus obliteration or cranialization) can be considered for significant disruption of the posterior table (displacement >1 table width), CSF leak, and nasofrontal tract obstruction. 19,20 Frontal sinus obliteration is performed in the presence of significant posterior table displacement and nasofrontal tract obstruction. Frontal sinus cranialization should be considered with CSF leak and/or severe comminution of the posterior table.…”

Section: Frontal Sinus Fracturementioning

confidence: 99%

Neurosurgical and Intensive Care Management of Traumatic Brain Injury

et al. 2015

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Optimal management of patients with traumatic brain injury (TBI) remains a challenge, despite significant improvements in pathophysiologic understanding and treatment strategies in recent decades. Because primary brain injury sustained at the time of trauma is irreversible, the TBI management mainly aims for early detection and treatment of secondary brain injury such as space-occupying intracerebral hematomas and brain edema. Prevention of secondary brain injury requires a high standard of care and understanding of both medical and surgical treatment modalities. This review focuses on practical recommendations for neurosurgical and intensive care management in patients with severe TBI.

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Cerebrospinal fluid fistula prevention and treatment following frontal sinus fractures: a review of initial management and outcomes

Cited by 12 publications

References 30 publications

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Secondary Reconstruction of Frontal Sinus Fracture

Neurosurgical and Intensive Care Management of Traumatic Brain Injury

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