Combined Supraciliary and Endoscopic Endonasal Approach for Resection of Frontal Sinus Mucoceles: Technical Note

Abstract

Objective: Mucoceles are progressive, slow-growing lesions of the paranasal sinuses that, left untreated, can erode into surrounding structures. Complete obliteration and exenteration of the frontal sinus via a bicoronal skin incision and frontal craniotomy is the standard neurosurgical approach to treat these lesions.

Technique: We describe two patients who underwent a combined supraciliary “keyhole” craniotomy and endonasal endoscopic resection of mucoceles with frontal sinus obliteration. The technique takes advantage of a smaller incision, while preserving adequate visualization and the ability for surgical instrumentation. Through the craniotomy, the frontal sinus mucosa is fully exenterated, the posterior table of the sinus is removed to establish communication with the intracranial space, and the nasal frontal ducts are packed with autologous tissue. The endoscopic endonasal route allows a minimally invasive access to the frontal nasal duct to ensure its blockage from the intracranial compartment. Additionally, the endoscope can be used from above through the supraciliary approach to allow for contralateral frontal sinus exposure and mucosal exenteration.

Conclusion: The combined supraciliary-endoscopic endonasal approach provides a minimally invasive access for the treatment of sinonasal disease with frontal sinus mucoceles that invade the intracranial cavity.

Key words

supraciliary craniotomy - endoscopy - keyhole approach - frontal sinus mucocele

References

• 1 Delashaw  Jr  JB, Tedeschi H, Rhoton AL. Modified supraorbital craniotomy: technical note.  Neurosurgery. 1992;  30 954-956
• 2 Delashaw  Jr  JB, Jane JA, Kassell NF. et al . Supraorbital craniotomy by fracture of the anterior orbital roof.  Technical note. J Neurosurg. 1993;  79 615-618
• 3 Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach.  Minim Invas Neurosurg. 1997;  40 91-97
• 4 Jane JA, Park TS, Pobereskin LH. et al . The supraorbital approach: technical note.  Neurosurgery. 1982;  11 537-542
• 5 Noggle JC, Sciubba DM, Nelson C. et al . Supraciliary keyhole craniotomy for brain abscess debridement.  Neurosurg Focus. 2008;  24 E11
• 6 Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy.  Surg Neurol. 2003;  59 223-227
• 7 Czirjak S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision.  Neurosurgery. 2001;  48 145-149
• 8 Dare AO, Landi MK, Lopes DK. et al . Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation.  Technical note. J Neurosurg. 2001;  95 714-718
• 9 Paladino J, Pirker N, Stimac D. et al . Eyebrow keyhole approach in vascular neurosurgery.  Minim Invas Neurosurg. 1998;  41 200-203
• 10 Ramos-Zuniga R, Velazquez H, Barajas MA. et al . Transsupraorbital approach to supratentorial aneurysms.  Neurosurgery. 2002;  51 125-130
• 11 Steiger HJ, Schmid-Elsaesser R, Stummer W. et al . Transorbital keyhole approach to anterior communicating artery aneurysms.  Neurosurgery. 2001;  48 347-351
• 12 Lindert E van, Perneczky A, Fries G. et al . The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.  Surg Neurol. 1998;  49 481-489
• 13 Sakae FA, Filho BCA, Lessa M. et al . Bilateral frontal sinus mucocele.  Rev Bras Otorrinolaringol. 2006;  72 428
• 14 Santoro PP, Medeiros IRT, Queiroz E. et al . Mucocele Frontal Bilateral.  Arquivos da Fundacao Otorrinolaringologia. 1999;  3 14-18
• 15 Lai PC, Liao SL, Jou JR. et al . Transcaruncular approach for the management of frontoethmoid mucoceles.  Br J Ophthalol. 2003;  87 699-703
• 16 Herndon M, McMains KC, Kountakis SE. Presentation and management of extensive fronto-orbital-ethmoid mucoceles.  Am J Otolaryngol. 2007;  28 145-147
• 17 Cheney ML, Gliklich R, Li KK. et al . Midforehead incision: an approach to the frontal sinus and upper face.  J Craniofac Surg. 1995;  6 408-411
• 18 Ikeda K, Takahashi C, Oshima T. et al . Endonasal endoscopic marsupialization of paranasal sinus mucoceles.  Am J Rhinol. 2000;  14 107-111
• 19 Krishnan G, Kumar G. Frontoethmoid mucocele: one-year follow-up after endoscopic frontoethmoidectomy.  J Otolaryngol. 1996;  25 37-40
• 20 Ulualp SO, Carlson TK, Toohill RJ. Osteoplastic flap versus modified endoscopic Lothrop procedure in patients with frontal sinus disease.  Am J Rhinol. 2000;  14 21-26
• 21 Donald PJ. Frontal sinus ablation by cranialization: report of 21 cases.  Arch Otolaryngol. 1982;  108 142-146
• 22 Nakajima Y, Yoshimine T, Ogawa M. et al . A giant intracranial mucocele associated with an orbitoethmoidal osteoma.  Case report. J Neurosurg. 2000;  92 697-701
• 23 Kaplan MJ, Jane JA, Park TS. et al . Supraorbital rim approach to the anterior skull base.  Laryngoscope. 1984;  94 1137-1139
• 24 Smith RR, Al-Mefty O, Middleton TH. An orbitocranial approach to complex aneurysms of the anterior circulation.  Neurosurgery. 1989;  24 385-391
• 25 Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2 − Analysis of 380 procedures.  Neurosurgery. 1998;  42 226-232
• 26 Knosp E, Muller G, Perneczky A. The paraclinoid carotid artery: Anatomical aspects of a microneurosurgical approach.  Neurosurgery. 1988;  22 896-901
• 27 Menovsky T, Grotenhuis A, de Vries J. et al . Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.  Neurosurgery. 1999;  44 106-112
• 28 Perneczky A. Planning strategies for the suprasellar region: Philosophy of approaches.  Neurosurgeons. 1992;  11 343-348
• 29 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision.  Neurosurgery. 2005;  57 242-255

Correspondence