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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 4 | Page : 447-448 |
Incidental giant frontal sinus mucocele with intracranial extension
Rakshith Srinivasa, Ravi Dadlani, Alangar S Hegde
Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| Date of Submission | 08-Jul-2013 |
| Date of Decision | 09-Jul-2013 |
| Date of Acceptance | 21-Jul-2013 |
| Date of Web Publication | 4-Sep-2013 |
Correspondence Address:
Ravi Dadlani
Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.117606
How to cite this article:
Srinivasa R, Dadlani R, Hegde AS. Incidental giant frontal sinus mucocele with intracranial extension. Neurol India 2013;61:447-8 |
Sir,
Frontal sinus mucoceles (FSM) are rare pathologies encountered by the neurosurgeon. These are chronic, expanding and mucosa-lined retention cysts occurring due to obstruction of the sinus ostium. [1] FSM expand by eroding the surrounding bony walls by pressure and bony resorption and may extend into the orbit or rarely intracranially. [1] FSM usually present with pain, swelling, exophthalmos, diplopia and loss of vision, rarely with meningitis, meningoencephalitis, pneumocephalus, brain abscess, seizures and cerebrospinal fluid fistulas. [2] In this case, we report an FSM with intracranial extension into the anterior cranial fossa diagnosed incidentally.
A 48-year-lady, evaluated for a minor head injury sustained when a coconut fell on her head, presented with mild, holocranial headaches. She had no neurological deficits. The lesion was diagnosed on pre-operative radiology as demonstrated in [Figure 1]. The lesion was approached through a right frontal craniotomy. The frontal bone was extremely thin and the cyst wall was firmly adhered to the inner table of the frontal bone extending into the frontal sinus [Figure 2]b. The cyst was extradural and ruptured during craniotomy to expose yellowish, thick, mucoid material [Figure 2]a, which was aspirated and the wall was peeled of the bone and excised. The front nasal duct was obliterated and the exenterated frontal sinus thus was packed with muscle, gel foam and bone wax. The post-operative period was uneventful. The cyst wall and cyst contents were sterile on culture for aerobic and anerobic bacteria. | Figure 1: (a and b) Depict the T1W and T2W images of a right frontal sinus giant mucocele. The contents appear hypointense on T1W image and hyperintense on T2W image. (d) It is the post‑contrast coronal T1W image demonstrating minimal rim enhancement. The extension into the frontal sinus is marked by a white block arrow in a, b and d. (c) The splaying of the walls of the frontal sinus is demonstrated (small white arrows)
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 | Figure 2: Intra‑operative images. (a) This exhibits the mucoid contents of the sac. (b) This is after evacuation of the contents. The hiatus into the frontal sinus is seen in figure 'b' and is marked with a white arrow
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Expansile growth of the FSM may result in remodeling or destruction of the posterior wall of the frontal sinus. [3]
The definitive treatment of mucoceles is primarily surgical removal of the sac and the offending obstruction with re-establishment of normal sinus drainage. Success rates ranging from 78% to 97% have been reported. [4] Surgical management is the only treatment of choice. [4] Endoscopic sinus surgery can be used to evacuate the mucocele, but this procedure is more difficult in case of lateral intracranial expansion of the cyst, as in our case. [4] The external open approach has the advantages of being a direct approach, with allows exposure of the entire sinus, provides complete obliteration of the sinus to prevent recurrence of the sinus disease and prevents blind curettage of any exposed dura mater. Minor head injury may prove to be an excellent excuse to diagnose incidental intracranial pathologies. The prognosis for FSM is excellent with the likelihood of cure and a low incidence of recurrence.
| » References | |  |
| 1. | Yap SK, Aung T, Yap EY. Frontal sinus mucoceles causing proptosis - Two case reports. Ann Acad Med Singapore 1998;27:744-7. 
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| 2. | Peral Cagigal B, Barrientos Lezcano J, Floriano Blanco R, García Cantera JM, Sánchez Cuéllar LA, Verrier Hernández A. Frontal sinus mucocele with intracranial and intraorbital extension. Med Oral Patol Oral Cir Bucal 2006;11:E527-30.
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| 3. | Suri A, Mahapatra AK, Gaikwad S, Sarkar C. Giant mucoceles of the frontal sinus: A series and review. J Clin Neurosci 2004;11:214-8.
[PUBMED] |
| 4. | Constantinidis J, Steinhart H, Schwerdtfeger K, Zenk J, Iro H. Therapy of invasive mucoceles of the frontal sinus. Rhinology 2001;39:33-8.
[PUBMED] |
[Figure 1], [Figure 2]
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