Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature
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RHINOLOGY
Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature F. M. Crocetta1,2 · P. Farneti3 · G. Sollini4 · A. Castellucci2 · A. Ghidini2 · M. C. Spinosi1 · I. J. Fernandez5 · M. Zoli6 · D. Mazzatenta6 · E. Pasquini4 Received: 7 June 2020 / Accepted: 28 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. Methods We retrospectively evaluated 22 patients who referred to Sant’Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. Results In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. Conclusion Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation. Keywords Endoscopic sinus surgery · Frontal sinus · Sinusitis · Mucocele · Craniotomy · Obliteration · Cranialization
Introduction * F. M. Crocetta [email protected] 1
ENT Department, Sant’Orsola‑Malpighi Hospital, University of Bologna, Bologna, Italy
2
ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
3
ENT Department, Santa Maria Della Scaletta Hospital, Imola, BO, Italy
4
ENT Department, Bellaria Hospital, Bologna, Italy
5
ENT Department, University Hospital of Modena, Modena, Italy
6
Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
Opening of the fron
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