Maria Licci1, Christian Zweifel1, Jürgen Hench2, Raphael Guzman1, Jehuda Soleman3. 1. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland. 2. Department of Neuropathology, University Hospital of Basel, Basel, Switzerland. 3. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland. Electronic address: jehuda.soleman@gmail.com.
Abstract
BACKGROUND: Paranasal sinus osteoma is a common, asymptomatic, histologically benign, slow-growing tumor. However, it can give rise to secondary pathologies such as a mucocele in about 50% of the cases. Rarely, intracranial and orbital extension is present, leading to rhinoliquorrhea, pneumocephalus, or neurologic and visual impairment, which might be potentially life-threatening. CASE DESCRIPTION: A 49-year-old man presented with an acute frontal lobe syndrome and rhinoliquorrhea. Cranial magnetic resonance tomography showed a suspected frontoethmoidal osteoma with a mucocele expanding intradurally into the left frontal lobe. It was accompanied by pneumocephalus and showed communication with the left lateral ventricle. Through a bifrontal craniotomy, in toto resection of the frontoethmoidal bony tumor and the intradural mucocele was performed, while thereafter the frontal sinus was cranialized using a pedunculated periosteal flap. Postoperative recovery was uneventful with complete resolution of the tension pneumocephalus and rhinoliquorrhea and led to an improvement of the frontal lobe syndrome. CONCLUSIONS: We present a rare case of pneumocephalus caused by a frontoethmoidal osteoma associated with an intradural mucocele. A review of the literature, focusing on the surgical strategies in such cases, is provided.
BACKGROUND: Paranasal sinus osteoma is a common, asymptomatic, histologically benign, slow-growing tumor. However, it can give rise to secondary pathologies such as a mucocele in about 50% of the cases. Rarely, intracranial and orbital extension is present, leading to rhinoliquorrhea, pneumocephalus, or neurologic and visual impairment, which might be potentially life-threatening. CASE DESCRIPTION: A 49-year-old man presented with an acute frontal lobe syndrome and rhinoliquorrhea. Cranial magnetic resonance tomography showed a suspected frontoethmoidal osteoma with a mucocele expanding intradurally into the left frontal lobe. It was accompanied by pneumocephalus and showed communication with the left lateral ventricle. Through a bifrontal craniotomy, in toto resection of the frontoethmoidal bony tumor and the intradural mucocele was performed, while thereafter the frontal sinus was cranialized using a pedunculated periosteal flap. Postoperative recovery was uneventful with complete resolution of the tension pneumocephalus and rhinoliquorrhea and led to an improvement of the frontal lobe syndrome. CONCLUSIONS: We present a rare case of pneumocephalus caused by a frontoethmoidal osteoma associated with an intradural mucocele. A review of the literature, focusing on the surgical strategies in such cases, is provided.
Authors: Sarmad Aburas; Benedikt Schneider; Florian Pfaffeneder-Mantai; Oliver Meller; Arne Balensiefer; Dritan Turhani Journal: Ann Med Surg (Lond) Date: 2022-05-18