Toward a more rationalized use of a special technique for repair of frontal air sinus after cerebral aneurysm surgery: The most effective technique

Reconstruction of the Large Frontal Sinus Defect With the Small Supporting Bone Pieces in Neurosurgical Anterior Skull Base Surgery

BACKGROUND

Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully.

METHODS

Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected.

RESULTS

Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications.

CONCLUSIONS

Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.

The Usefulness of Surgical Titanium Microclips for Mucosal Repair in the Frontal Sinus Using ORBEYE: A Technical Note

Bifrontal craniotomy frequently involves opening the frontal sinus and mucosal injury. We report a new technique for mucosal repair in the frontal sinus using surgical titanium microclips. Six consecutive patients who underwent bifrontal craniotomy with frontal sinus exposure and mucosal injury underwent mucosal repair using surgical titanium microclips between April 2019 and August 2022. In all cases, the frontal sinus mucosa was peeled from the inner walls of the frontal sinus to ensure sufficient mucosal margin for clipping using ORBEYE. The repair was accomplished with the microclips in all cases. We also sealed the mucosal wound using fibrin glue and sufficiently filled the frontal sinus with bone debris, resulting in zero incidence of postoperative liquorrhea in all cases. Repairing the mucosa using surgical titanium microclips using ORBEYE may be a simple and quick technique when the frontal sinus mucosa is injured during craniotomy.

Multi-layer approach to complex traumatic anterior skull base fracture repair: A case report

Background

Anterior skull base fractures represent a unique challenge for neurosurgical repair due to the potential for orbital injury and the proximity to the air sinuses, yielding increased possibility for infection, and persistent cerebrospinal fluid (CSF) leak. While multiple techniques are available for the repair of anterior skull base defects, there exists a paucity of robust, long-term clinical data to guide the optimal surgical management of these fractures.

Case Description

We present the case of a complex, traumatic penetrating anterior skull base fracture, and describe a multi-layered approach for successful repair - namely, with the use of a temporally-based pericranial flap, split-thickness frontal bone graft, and autogenous abdominal fat graft. The patient was followed for nine months postoperatively, over which time she experienced no significant complications.

Conclusion

The goal of successful anterior skull base repair involves creating a durable, watertight separation between intra and extracranial compartments to prevent CSF leak, protect intracranial structures, and minimize infection risk. The temporally-based pericranial flap, split-thickness frontal bone graft, and autogenous abdominal fat graft represent safe and efficacious approaches to achieve lasting repair.

A practical and economical method for frontal sinus reconstruction after frontal craniotomy: A single-center experience with 140 patients

Background

Frontal sinus exposure is a common consequence of frontal craniotomy. Cerebrospinal fluid leakage and infection are the major postoperative complications that may occur as a result of the open frontal sinus. The successful filling of the open frontal sinus provides an approach to prevent significant complications caused by frontal sinus exposure.

Objective

This article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap.

Methods

A total of 140 patients underwent frontal sinus reconstruction using gelfoam and vascularized pericranial flaps from 2016 to 2021. Gelatin sponge was used to fill the frontal sinus, and a vascularized pericranial flap was used to cover the frontal sinus when the bone flap was retracted.

Results

Postoperative cerebrospinal fluid leakage and infection did not occur in any patient.

Conclusion

Our results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications.

Frontal Sinus Repair Using Polymethyl Methacrylate After Bifrontal Craniotomy

BACKGROUND

In many cases in which bifrontal craniotomy is performed, the frontal sinus is opened, and postoperative complications occur. Various methods to close the frontal sinus have been reported. However, all these methods require skill to perform and take time. The aim of this study was to report results obtained with closure of the frontal sinus using polymethyl methacrylate, which is a simpler method.

METHODS

From December 2008 to June 2018, 122 patients with a ruptured anterior communicating aneurysm were transported to the authors' facility, and 52 patients consecutively underwent bifrontal craniotomy with opening of the frontal sinuses, which were then filled with polymethyl methacrylate.

RESULTS

Mean follow-up period was 21.8 months; the longest follow-up was 116 months. No cerebrospinal fluid leakage or other complications were observed.

CONCLUSIONS

The method of filling the frontal sinus with polymethyl methacrylate reported in this study was safe and had no complications. This method should be considered as a method of frontal sinus closure.