Frontal sinus repair after bifrontal craniotomy: A single center experience

Abstract

In this study, we analyzed the patients who underwent surgery using their adipose tissue, which is a practical and economical approach to the reconstructing the frontal sinus during bifrontal craniotomy. The study aimed to evaluate the economic feasibility and safety of this classical technique to repair the frontal sinus and reduce complications.Patients who were underwent bifrontal craniotomy for anterior skull base tumors and underwent intraoperative frontal sinus repair between January 1, 2016 and January 1, 2022 were retrospectively evaluated. Demographic characteristics of the patients (age, gender), duration of hospitalization, etiological causes, post operation complications, management of complications, and follow-up periods were analyzed.A total of 25 patients were included in the study. Of the patients, 11 were male (46%) and 14 were female (54%). The median age of the patients was 59 (49.5–66) years. The median duration of hospitalization and follow-up period were 7 (6–8.5) days and 27 (17–48) months, respectively. Cerebrospinal fluid leakage developed as a complication in only one patient (4%) in the postoperative period. We applied the classical technique of using the patient's own adipose tissue for repair after frontal sinus opening that occurs in bifrontal craniotomies for anterior skull base tumors. This is a practical, effective, and economical method that causes less harm to patients.

Keywords

• bifrontal craniotomy
• frontal sinus
• reconstruction

References

1. 1. Fliss DM, Gil Z, Spektor S, Leider-Trejo L, Abergel A, Khafif A, et al. Skull base reconstruction after anterior subcranial tumor resection. Neurosurg Focus. (2002) 12:e10. doi: 10.3171/foc.2002.12.5.11
2. 2. Chhabra R, Gupta SK, Mohindra S, Mukherjee K, Bapuraj R, Khandelwal N, et al. Distal anterior cerebral artery aneurysms: bifrontal basal anterior interhemispheric approach. Surg Neurol. (2005) 64:315–9; discussion 320. doi: 10.1016/j.surneu.2005.03.038
3. 3. Kryzanski JT, Annino DJ Jr, Heilman CB. Complication avoidance in the treatment of malignant tumors of the skull base. Neurosurg Focus. (2002) 12:e11. doi: 10.3171/foc.2002.12.5.12
4. 4. El-Noamany, H., Nakagawa, F., Hongo, K., Kakizawa, Y., & Kobayashi, S. (2001). Low anterior interhemispheric approach–a narrow corridor to aneurysms of the anterior communicating artery. Acta neurochirurgica, 143(9), 885-891.
5. 5. Feiz-Erfan, I., Han, P. P., Spetzler, R. F., Horn, E. M., Klopfenstein, J. D., Kim, L. J., ... & Joganic, E. F. (2005). Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients. Operative Neurosurgery, 57(suppl_1), 86-93.
6. 6. Babu, R., Barton, A., & Kasoff, S. S. (1995). Resection of olfactory groove meningiomas: technical note revisited. Surgical neurology, 44(6), 567-571.
7. 7. Hasegawa, M., Torii, S., Fukuta, K., & Saito, K. (1995). Reconstruction of the anterior cranial base with the galeal frontalis myofascial flap and the vascularized outer calvarial bone graft. Neurosurgery, 36(4), 725-731.
8. 8. Kryzanski, J. T., Annino, D. J., Gopal, H., & Heilman, C. B. (2008). Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull base, 18(04), 229-241.

9. 9. Tuettenberg, J., Czabanka, M., Horn, P., Woitzik, J., Barth, M., Thomé, C., ... & Muench, E. (2009). Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. Journal of neurosurgery, 110(6), 1200-1208.
10. 10. Costa, H., Cerejo, A., Baptista, A., Vaz, R., Gonçalves, M., Guimara, A., ... & Guimara, F. (1993). The galea frontalis myofascial flap in anterior fossa CSF leaks. British journal of plastic surgery, 46(6), 503-507.
11. 11. Horowitz, G., Amit, M., Ben-Ari, O., Gil, Z., Abergel, A., Margalit, N., ... & Fliss, D. M. (2013). Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions. PLoS One, 8(12), e83820.
12. 12. Siniscalchi, E. N., Angileri, F. F., Mastellone, P., Catalfamo, L., Giusa, M., Conti, A., ... & Tomasello, F. (2007). Anterior skull base reconstruction with a galeal-pericranial flap. Journal of Craniofacial Surgery, 18(3), 622-625.
13. 13. Weber, R., Draf, W., Keerl, R., Kahle, G., Schinzel, S., Thomann, S., & Lawson, W. (2000). Osteoplastic frontal sinus surgery with fat obliteration: technique and long‐term results using magnetic resonance imaging in 82 operations. The Laryngoscope, 110(6), 1037-1044.
14. 14. Matsuura, J., Otsuka, T., Nakagawa, T., & Kai, K. (2019). Frontal sinus repair using polymethyl methacrylate after bifrontal craniotomy. World Neurosurgery, 124, e281-e284.
15. 15. Liu, T. C., Yu, X. F., Gu, Z. W., Bai, W. L., Wang, Z. H., & Cao, Z. W. (2018). Causes and management of frontal sinusitis after transfrontal craniotomy. Lin Chuang er bi yan hou tou Jing wai ke za zhi= Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery, 32(3), 187-189.
16. 16. Peters DR, Payne C, Wait SD. Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus. J Neurol Surg B Skull Base. 2021 Jul;82(Suppl 3):e190-e195. doi: 10.1055/s-0039-3402025. Epub 2020 Jan 24. PMID: 34306936; PMCID: PMC8289512.
17. 17. Farag A, Rosen MR, Ziegler N, Rimmer RA, Evans JJ, Farrell CJ, Nyquist GG. Management and Surveillance of Frontal Sinus Violation following Craniotomy. J Neurol Surg B Skull Base. 2020 Feb;81(1):1-7. doi: 10.1055/s-0038-1676826. Epub 2019 Jan 21. PMID: 32021743; PMCID: PMC6997004.
18. 18. Murai, Y., Mizunari, T., Kobayashi, S., & Teramoto, A. (2014). Surgical technique for the prevention of cerebrospinal fluid leakage after bifrontal craniotomy. World neurosurgery, 81(2), 344-347.
19. 19. Le P, Martinez R, Black J. Frontal Sinus Fracture Management Meta-analysis: Endoscopic Versus Open Repair. J Craniofac Surg. 2021 Jun 1;32(4):1311-1315. doi: 10.1097/SCS.0000000000007181. PMID: 33181610.
20. 20. Su-Velez BM, Hsu DW, West AN, Suh JD. Single Layer Biomaterial Repair of Frontal Sinus Encephalocele in a Pediatric Patient. Laryngoscope. 2021 Jun;131(6):E1750-E1752. doi: 10.1002/lary.29198. Epub 2020 Oct 27. PMID: 33107603.
21. 21. Bozkurt G, Zocchi J, Russo F, Pietrobon G, Karligkiotis A, Elhassan HA, Seyhun N, Bignami M, Castelnuovo P. Frontal Sinus Preservation During Cerebrospinal Fluid Leak Repair. J Craniofac Surg. 2019 Nov-Dec;30(8):e763-e768. doi: 10.1097/SCS.0000000000005764. PMID: 31348205.
22. 22. Eroglu U, Shah K, Bozkurt M, Kahilogullari G, Yakar F, Dogan İ, Ozgural O, Attar A, Unlu A, Caglar S, Cohen Gadol AA, Ugur HC. Supraorbital Keyhole Approach: Lessons Learned from 106 Operative Cases. World Neurosurg. 2019 Jan 17:S1878-8750(19)30060-9. doi: 10.1016/j.wneu.2018.12.188. Epub ahead of print. PMID: 30659969.
23. 23. D'Addario, M., Haug, R. H., & Talwar, R. M. (2004). Biomaterials for use in frontal sinus obliteration. Journal of Long-Term Effects of Medical Implants, 14(6).
24. 24. Rohrich, R. J., & Mickel, T. J. (1995). Frontal sinus obliteration: in search of the ideal autogenous material. Plastic and reconstructive surgery, 95(3), 580-585.
25. 25. Monnazzi, M., Gabrielli, M. F. R., Gabrielli, M., Hochuli-Vieira, E., & Pereira-Filho, V. (2011). Frontal sinus obliteration with iliac crest bone grafts. International Journal of Oral and Maxillofacial Surgery, 40(10), 1119.
26. 26. Sailer, H. F., Grätz, K. W., & Kalavrezos, N. D. (1998). Frontal sinus fractures: principles of treatment and long term results after sinus obliteration with the use of lyophilized cartilage. Journal of Cranio-Maxillofacial Surgery, 26(4), 235-242.
27. 27. Mori, K., Nakajima, M., & Maeda, M. (2003). Simple reconstruction of frontal sinus opened during craniotomy using small autogenous bone piece. Surgical neurology, 60(4), 326-328.
28. 28. Petruzzelli, G. J., & Stankiewicz, J. A. (2002). Frontal sinus obliteration with hydroxyapatite cement. The Laryngoscope, 112(1), 32-36.
29. 29. Solomon, L. B., Guevara, C., Büchler, L., Howie, D. W., Byard, R. W., & Beck, M. (2012). Does bone wax induce a chronic inflammatory articular reaction?. Clinical Orthopaedics and Related Research®, 470(11), 3207-3212.
30. 30. Elahi, M. M., Vanduzer, S., Spears, J., Gibson, J., & Mitra, A. (2004). Frontal sinus obliteration with β-tricalcium phosphate. Journal of Craniofacial Surgery, 15(6), 967-970.
31. 31. Peltola, M. J., Aitasalo, K. M., Aho, A. J., Tirri, T., & Suonpää, J. T. (2008). Long-term microscopic and tissue analytical findings for 2 frontal sinus obliteration materials. Journal of oral and maxillofacial surgery, 66(8), 1699-1707.
32. 32. Milton CK, Andrews BJ, Baker CM, O'Connor KP, Conner AK, Sughrue ME, McKinney KA, El Rassi ET, Sanclement JA, Glenn CA. Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma. J Neurol Surg B Skull Base. 2020 Nov 26;83(2):116-124. doi: 10.1055/s-0040-1718765. PMID: 35433178; PMCID: PMC9010133.
33. 33. Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal sinus breach during routine frontal craniotomy significantly increases risk of surgical site infection: 10-year retrospective analysis. Neurosurgery 2017;81(03):504–511
34. 34. Das, J. M. (2018). Bone wax in neurosurgery: a review. World Neurosurgery, 116, 72-76.
35. 35. Sataloff, R. T., Sariego, J., Myers, D. L., & Richter, H. J. (1984). Surgical management of the frontal sinus. Neurosurgery, 15(4), 593-596.
36. 36. Montgomery WW: Surgery of the frontal sinuses. Otolaryngol Clin North Am 4:97-126, 1971
37. 37. Luce, E. A. (1987). Frontal sinus fractures: guidelines to management. Plastic and reconstructive surgery, 80(4), 500-510.
38. 38. Dickson, R., & Hohmann, A. (1971). The fate of exogenous materials placed in the middle ear and frontal sinus of cats. The Laryngoscope, 81(2), 216-231.
39. 39. BERGARA, A. R., & ITOIZ, A. O. (1955). Present state of the surgical treatment of chronic frontal sinusitis. AMA archives of otolaryngology, 61(6), 616-628.
40. 40. Montgomery, W. W. (1963). Anterior osteoplastic fat obliteration for frontal sinus; clinical experience and animal studies. Trans Am Acad Ophthalmol Otolaryngol, 67, 46-57.