Abstract
Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional
breach of the frontal sinus. These techniques, however, result in the loss of frontal
sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele.
Compartmentalization is an open technique for repair of the frontal sinus using allograft
onlay and a vascularized periosteal flap that allows for preservation of frontal sinus
function.
Objective The main objective of this article is to describe the technique for compartmentalization
of the frontal sinus and demonstrate its efficacy and complication rate with an early
patient series.
Methods Our technique includes the following key components: harvesting of a pedicled periosteal
flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal,
ensuring the patency of the nasal frontal outflow tract, and separation of the brain
from the frontal sinus with a dual layer of periosteum and allograft.
All cases of frontal sinus repair using the compartmentalization technique at our
institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other
complications.
Results Twenty-three patients underwent the described frontal sinus repair technique 17 for
tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced
postoperative anemia and a “parameningeal reaction” that were managed with a short
course of antibiotics.
Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents
a meaningful step forward in neurosurgical technique for open frontal sinus repair.
However, long-term outcomes are necessary to fully evaluate risk of mucocele.
Keywords
compartmentalization - cranialization - frontal sinus - periosteal flap - skull base
repair - trauma - tumor
