Satoru Takeuchi1, Rokuya Tanikawa2, Makoto Katsuno3, Toshiyuki Tsuboi2, Kosumo Noda2, Junpei Oda2, Shiro Miyata2, Nakao Ota2, Hiroyasu Kamiyama2. 1. Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan; Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan. Electronic address: s.takeuchi@room.ocn.ne.jp. 2. Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan. 3. Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Hokkaido, Japan.
Abstract
BACKGROUND: Bifrontal craniotomy is effective for the treatment of anterior skull base lesions. However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid leakage and infection. We describe our procedure for maintaining the patency of the nasofrontal duct and direct suture of the exposed and violated FS mucosa. METHODS: Bifrontal craniotomy with reconstruction of the FS was performed in 103 patients (68 women and 35 men; age range, 32-90 years; mean age, 62.6 years) for lesions including anterior cerebral artery aneurysm (100 cases), arteriovenous fistula (1 case), and meningioma (2 cases). After opening the FS, the mucosal membrane of the FS was dissected from the FS wall, and the orifice of the FS mucosa was closed with 7-0 monofilament running sutures. The nasofrontal duct was kept open by washing thoroughly to remove any bone dust and clot in the FS. The cavity of the FS was then packed with abdominal fat. RESULTS: Postoperative cerebrospinal fluid leakage and mucocele formation did not occur in any patient. An intracranial infectious complication occurred in 1 patient (1.0%). CONCLUSIONS: The present results indicate the effectiveness of our technique for the prevention of FS-related postoperative complications.
BACKGROUND: Bifrontal craniotomy is effective for the treatment of anterior skull base lesions. However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid leakage and infection. We describe our procedure for maintaining the patency of the nasofrontal duct and direct suture of the exposed and violated FS mucosa. METHODS: Bifrontal craniotomy with reconstruction of the FS was performed in 103 patients (68 women and 35 men; age range, 32-90 years; mean age, 62.6 years) for lesions including anterior cerebral artery aneurysm (100 cases), arteriovenous fistula (1 case), and meningioma (2 cases). After opening the FS, the mucosal membrane of the FS was dissected from the FS wall, and the orifice of the FS mucosa was closed with 7-0 monofilament running sutures. The nasofrontal duct was kept open by washing thoroughly to remove any bone dust and clot in the FS. The cavity of the FS was then packed with abdominal fat. RESULTS: Postoperative cerebrospinal fluid leakage and mucocele formation did not occur in any patient. An intracranial infectious complication occurred in 1 patient (1.0%). CONCLUSIONS: The present results indicate the effectiveness of our technique for the prevention of FS-related postoperative complications.
Authors: F M Crocetta; P Farneti; G Sollini; A Castellucci; A Ghidini; M C Spinosi; I J Fernandez; M Zoli; D Mazzatenta; E Pasquini Journal: Eur Arch Otorhinolaryngol Date: 2020-09-03 Impact factor: 2.503