Available online 10 January 2013
Publication year: 2013
Source:World Neurosurgery
Background Cerebrospinal fluid leakage and meningitis caused by frontal sinus exposure are characteristic complications of bifrontal craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. Objective We describe in detail our procedure for sealing exposed frontal sinuses during bifrontal craniotomy and present the results and outcomes of the procedure. Subjects and Methods: A total of 51 consecutive patients who had undergone bifrontal craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed frontal sinuses is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the frontal sinuses were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal basedura mater. Results/Conclusion Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients, indicating the effectiveness of our technique in the prevention of frontal sinus-related postoperative complications.
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