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J Neurol Surg B Skull Base 2021; 82(02): 189-195
DOI: 10.1055/s-0039-1696683
Original Article

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Christopher Miller
1   Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Luke Weisbrod
1   Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, Kansas, United States
,
David Beahm
2   Department of Otolaryngology, The University of Kansas School of Medicine, Kansas City, Kansas, United States
,
Roukoz Chamoun
1   Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, Kansas, United States
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Funding Sources None.
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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

Note

Prior presentations: Poster, North American Skull Base Society Meeting, Coronado, CA 2018. Poster, Resident and Post-Doc Research Forum. Kansas City, Kansas, Kansas University Medical Center, 2018.


Industry affiliations: None. In particular, no author has any financial interest in Aesculap, the manufacturer of Lyoplant mentioned in the manuscript.


Grants

None.




Publication History

Received: 16 February 2019

Accepted: 28 July 2019

Article published online:
12 September 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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