Rohan Ramakrishna1, M Nathan Nair1, Bertrand Huber1, Laligam N Sekhar2. 1. Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA. 2. Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA. Electronic address: lsekhar@u.washington.edu.
Abstract
OBJECTIVE: We report a rare case of recurrent frontal osteoma complicated by mucopyocele and intracranial abscess. Furthermore, we report an unusual organism, Moraxella catarrhalis, as the infectious agent. Finally, we demonstrate that endovascular embolization may be part of the treatment paradigm of frontal osteomas in selected cases. CASE DESCRIPTION: A 71-year-old man with a previous history of craniotomy presented to the emergency room with 24 hours of headache episodes, confusion, lethargy, and spells of low-grade fever. Imaging and angiography revealed a complex frontal lesion involving the frontoethmoidal sinuses that extended into the medial orbit and anterior skull base with multiple feeding vessels from the middle meningeal artery. The initial diagnosis of recurrent meningioma was made based on imaging data. The patient underwent partial angiographic embolization of the lesion followed by microneurosurgical complete resection. Pathology revealed a synchronous presentation of an osteoma and mucopyocele with intracranial abscess caused by M. catarrhalis. CONCLUSION: Synchronous presentation of a frontal osteoma with mucopyocele is a rare event. However, the case of a recurrent osteoma complicated by infection with M. catarrhalis has not been reported in the literature, nor a treatment paradigm that included preoperative partial endovascular embolization.
OBJECTIVE: We report a rare case of recurrent frontal osteoma complicated by mucopyocele and intracranial abscess. Furthermore, we report an unusual organism, Moraxella catarrhalis, as the infectious agent. Finally, we demonstrate that endovascular embolization may be part of the treatment paradigm of frontal osteomas in selected cases. CASE DESCRIPTION: A 71-year-old man with a previous history of craniotomy presented to the emergency room with 24 hours of headache episodes, confusion, lethargy, and spells of low-grade fever. Imaging and angiography revealed a complex frontal lesion involving the frontoethmoidal sinuses that extended into the medial orbit and anterior skull base with multiple feeding vessels from the middle meningeal artery. The initial diagnosis of recurrent meningioma was made based on imaging data. The patient underwent partial angiographic embolization of the lesion followed by microneurosurgical complete resection. Pathology revealed a synchronous presentation of an osteoma and mucopyocele with intracranial abscess caused by M. catarrhalis. CONCLUSION: Synchronous presentation of a frontal osteoma with mucopyocele is a rare event. However, the case of a recurrent osteoma complicated by infection with M. catarrhalis has not been reported in the literature, nor a treatment paradigm that included preoperative partial endovascular embolization.