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Complications of Rhinosinusitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Associated intracranial complications necessitate prompt neurosurgical intervention. This is typically performed through a bifrontal craniotomy enabling drainage of intracranial pus and removal of necrotic bone.50 Complete removal of the posterior table will require frontal sinus cranialization. Extensive osteomyelitis of the anterior table may necessitate a Riedel’s procedure51 with removal of the anterior wall and floor of the frontal sinus allowing the forehead skin to collapse onto the posterior table. Whilst this causes a significant cosmetic deformity, reconstruction with split calvarial bone or alloplastic materials can be undertaken at a later stage when all infection has resolved.52
Complications of Rhinosinusitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Associated intracranial complications necessitate prompt neurosurgical intervention. This is typically performed through a bifrontal craniotomy enabling drainage of intracranial pus and removal of necrotic bone. Complete removal of the posterior table will require frontal sinus cranialisation. Extensive osteomyelitis of the anterior table may necessitate a Riedel's procedure with removal of the anterior wall and floor of the frontal sinus allowing the forehead skin to collapse onto the posterior table. The cosmetic deformity can be reconstructed when all infection has resolved.
The viva: operative surgery and surgical anatomy
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Large tumours (>3 cm) are approached by a bifrontal craniotomy, then subfrontal approach. The sagittal sinus and falx are divided anteriorly. Small tumours are approached by unilateral subfrontal or pterional approach; if midline, the right side is preferred.
Cerebrospinal fluid leak management in anterior basal skull fractures secondary to head trauma
Published in Neurological Research, 2022
Jian-Cheng Liao, Buqing Liang, Xiang-Yu Wang, Jason H. Huang
There is evidence that CSF leaks that persist for >7 days have a significantly higher rate of meningitis [3]. For this reason, conservative therapy should be continued ideally for no more than 7 days unless the patient is too unstable for surgical repair. At our institute, surgical repair of the CSF leak would normally be considered after 7 days of conservative management, which is in consensus with some other authors [27,28]. Open surgical treatment of frontobasal skull fractures is often a multidisciplinary effort with surgical subspecialists in neurological surgery; otorhinolaryngology; orbitomaxillofacial surgery, and plastic surgery. The exact type and location of surgery depend on the fracture pattern and goal. The most common location of dural tears is at the cribriform plate of the ethmoid bone, posterior frontal sinus, or planu sphenoidale [29]. The dural repair could be achieved either intradurally or extradurally, depending on the surgeon’s preference and expertise. The approach routinely includes standard bicoronal incision and bifrontal craniotomy. Intradural approach possesses the advantage of avoiding additional dural tear caused by dissection, thus perplexing the identification of exiting versus iatrogenic durotomy. Although this approach has a low failure rate of less than 3%, there is increased morbidity from brain retraction [30]. Approximately 8% of intradural approaches for traumatic frontobasal skull fractures have frontal lobe injury. Meanwhile, the entire anterior fossa, including bony defects, could be better exposed in extradural approach [4]. Materials such as pedicled pericranial falp, temporalis muscle, autologous fascia lata, collagen graft, and adhesive glue have all been utilized for repair (Figure 2).
Endoscopic frontal trephination verse the osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy
Published in British Journal of Neurosurgery, 2021
Pengcheng Yu, Xiaomeng Mao, Xumao Li, Xinqi Hu, Jiaying Li, Guangbin Sun
Bifrontal craniotomy is the standard neurosurgical approach to treat anterior skull base lesions, and it requires entry into the frontal sinus. Although many methods have been proposed to avoid the frontal sinus complications, they may still occur. Patients can present with symptoms of headache, forehead pressure, and forehead skin fistula with purulent discharge.1,2 Predisposing factors include incomplete removal of frontal sinus mucosa, obstruction of the frontal recess, or inflammation of mucosa secondary to foreign bodies.3