Large Intracranial Intradural Mucocele as a Complication of Frontal Sinus Osteoma

Abstract

Paranasal sinus osteomas are mostly asymptomatic; however, secondary mucocele can develop if they impede the natural sinus drainage. Such a mucocele can destroy the bone and extend into the adjacent structures. We report on an unusual case of frontal sinus osteoma in a 27-year-old patient, complicated by large secondary mucocele that eroded the bone and extended into the frontal lobe of the brain. Unexpectedly, the patient did not report any visual or other symptoms attributable to central nervous system deficit. The mucocele was completely resected through bifrontobasal osteoplastic craniotomy, whereas osteoma was evacuated in its entirety by both drilling and mobilizing. Open surgical approach remains the main treatment for complicated paranasal sinus osteoma, and radical removal of intracranial mucocele is mandatory to prevent the development of life-threatening infections. Although intradural extension of a secondary mucocele is extremely unusual, head and neck surgery specialists should take this severe complication in consideration.

Osteoma of the Skull Base and Sinuses

“…17 Complete obstruction of a sinus ostium by an osteoma may lead to secondary formation of mucocele. 25,26 When an osteoma extends beyond the confines of the sinuses, it may produce an external deformity (Fig. 3).…”

Importance of MRI in the diagnosis of a rare intracranial mucocele associated with frontal paranasal osteoma: Case report and literature review

“…They are benign, expansile lesions that are characterized by a slow and gradual growth, remaining asymptomatic for a long time and often being diagnosed incidentally [1 , 2] . When symptomatic, common manifestations of intracranial mucoceles include headaches, ophthalmological disturbances, as well as neurological anomalies such as seizures, dementia, and personality changes [3] .…”

“…Diagnosis is established through imaging and histological examinations. In this framework, surgical intervention is greatly advocated due to the high-risk of an intracranial expansion of the mucoceles and related neurological complications [6 , 7] .…”

A giant, complex fronto-ethmoidal ivory osteoma: Surgical technique in a resource-limited practice

“…[351214] Larger lesions, those up to 30 mm in diameter, are still more infrequent, but are more wont to be symptomatic by causing varying nasal/paranasal sinus inflammatory/infective and obstructive symptoms, and occasional intracranial/orbital complications. [2467131417] Surgical resection is then called for and many of these less than 30 mm lesions are safely excised via sundry minimally invasive techniques including external fronto-ethmoidectomy and even endoscopic endonasal methods. [1025]…”