ABSTRACT
Massive sinonasal polyposis associated with skull base dehiscence and intracranial
extension is a difficult disease to treat. Conventional transnasal or transfacial
techniques can result in dural injury, cerebrospinal fluid (CSF) leak and infection.
We describe our experience with a combined neurosurgical-endoscopic technique that
protects the meninges. Five patients with massive sinonasal polyposis extending intracranially
through skull base dehiscence were reviewed retrospectively. The minimum follow-up
was 2 years. A frontal craniotomy was performed through a bicoronal approach. The
dura was carefully separated from all infectious material at the floor of the anterior
cranial fossa. The frontal lobe with the intact meninges was elevated off the anterior
cranial floor. A sheet of blue plastic material was inserted under the frontal lobe
from the craniotomy site to the planum sphenoidale. Next, a transnasal endoscopic
ethmoidectomy, sphenoidectomy, and frontal sinusotomy were performed to remove the
inflammatory processes. The blue plastic material was visible through any existing
or potential skull base dehiscence, thus providing visual protection for the dura
and brain. All gross disease was removed from the frontal, ethmoid, and sphenoid skull
base regions in the 5 patients without dural injury. None of the patients developed
a CSF leak or meningitis. Two patients developed recurrent polyposis limited to the
sinuses without intracranial extension. The endoscopic craniofacial approach with
the “Blue-Sky” protective technique offers a safe method for completely removing massive
sinonasal polyposis associated with an intracranial extension.
KEYWORDS
Sinonasal polyposis - craniofacial resection
