Intracranial Management of Giant Mucoceles of the Frontal Sinus

Introduction: Frontal sinus mucoceles can expand to destroy the floor of the anterior skull base thus communicating directly with the frontal lobe dura and also can extend and adhere to the optic sheath. In most of the cases proptosis is present.

Methods: Soutar incision and bicoronal frontal craniectomy were performed. In all the cases there were very large dehiscences of the posterior wall of the frontal sinus with direct communication of the mucocele's capsule with the dura, as well as destruction of the lateral nasal walls and adhesion with the optic sheath. The capsule was dissected and the mucocele removed completely. The frontal recesses were obliterated with muscle, fat, and fibrin adhesives. Reconstruction of the anterior fossae floor was made with bone (internal plate of the frontal bone craniectomy), fat tissue, and fasciae grafts; the Bronson-Ray technique for pericranium preservation was used.

Results: Good results have been obtained with intracranial approaches using homologous materials for reconstruction.

Conclusion: Transnasal endoscopic approaches can be used for resection of frontoethmoidal mucoceles; however, for larger lesions, intracranial approaches are far better for dura and CSF leak control; bone defects can be fully visualized and repaired.