Frontal Sinus Violation and Management of Complications

Introduction: Frontal sinus violation often occurs incidentally during a craniotomy. There is an assortment of operative techniques that have been employed to manage this. A delayed complication can be frontal sinusitis or mucocele formation. Our objective was to review the published literature and our experience of frontal sinus complications after craniotomy with frontal sinus violation.

Methods: A retrospective analysis of our surgical experience and a literature review was performed between 1979 and 2014 in patients with frontal sinus complications after craniotomy. A PubMed database search of the English literature was performed and included articles identified from bibliographies of selected articles.

Results: A total of 7patients were treated at our institution and an additional 13 patients were reported in the literature. The average time interval between craniotomy and revision frontal sinus surgery was 15.7 years (range, 1–39 years). Multiple surgical techniques are described to manage this complication including endoscopic sinus surgery and open cranioplasty/cranialization approaches that address concurrent cosmetic deformities.

Conclusion: Similar to frontal sinus fractures, frontal sinus violation during craniotomy requires long-term surveillance for complications that include sinusitis and mucocele formation. In this study, we review ways to avoid frontal sinus violation during craniotomy, management of the frontal sinus when opened, common causes of frontal sinusitis and mucocele formation in the setting of craniotomy, and various surgical techniques to address and manage this delayed complication.