Contemporary applications of frontal sinus trephination: A systematic review of the literature

Abstract

Our objective was to perform a systematic review of the literature on contemporary indications and outcomes for frontal sinus trephination and present an illustrative case of an endoscopically assisted repair of a subcutaneous frontal sinus fistula by trephination technique. PubMed and Ovid databases were used as data sources. A systematic review of the English literature was completed to review reports of frontal trephination from 1980 to 2014. Articles meeting inclusion criteria for inflammatory and noninflammatory indications were reviewed. Articles were systematically reviewed and graded by evidence-based medicine level. An illustrative case from our institution is then presented. The systematic review identified 2,621 published studies. Thirty-eight studies were identified for inclusion. The indications, techniques, outcomes, safety, and complications were reviewed for noninflammatory and inflammatory conditions. There were 32 retrospective case series, reports, or cohort studies (level 4), four systematic reviews (level 3), one prospective analysis (level 3), and one meta-analysis (level 2). Due to the heterogeneity of study cases and inclusion criteria, a meta-analysis was not feasible. We also present a novel closure of an anterior skull base defect resulting in a subcutaneous fistula with use of a frontal trephination approach. The frontal sinus trephination should not be regarded as a procedure of the past, as it useful in the armamentarium of the modern sinus and skull base surgeon. This approach provides access for instrumentation for hard-to-reach frontal sinus disease either purely through a trephination approach or as a supplementation to the transnasal endoscopic approach. Evidence supporting frontal sinus trephination is of levels 2, 3, and 4. Level of evidence: NA.

Endoscopic management of frontal sinus CSF leaks

“…Frontal sinus trephination is a safe procedure with minimum risk of complications and excellent cosmetic results. 17 The complication rate encountered with frontal trephination is as low as 6.4%, the most common being infection at the trephine site. 18 …”

Two Cases of Frontal Sinus Inverted Papilloma Treated With a Combined Bifrontal Craniotomy and Endonasal Endoscopic Approach

“…The location and size of the osteotomy are determined by the exposure needed. The osteotomy enables visualization and instrumentation of a far lateral and superior lesion in the frontal sinus, with no significant risk of cosmetic deformity [10]. Although morbidity is minimal and the physiological function of the sinus is preserved without damaging the outflow tract of the frontal sinus, complications such as facial cellulitis and cerebrospinal fluid leakage can occur [10].…”

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

“…Trephination can be large enough to establish a surgical corridor for the endoscope and other surgical equipment, hence increasing sinus access. Trephination of the frontal sinuses is a relatively safe surgery with a low complications risk and great cosmetic outcomes [ 14 ].…”