A cautionary tale of hydroxyapatite cement use in frontal sinus obliteration

Abstract

Cerebrospinal fluid leak is a major complication of parasellar surgery and may be repaired using an extradural endoscopic approach involving extensive debridement of the sinus mucosa. The success rate of the endoscopic approach is approximately 90%, but in some difficult cases, sinus obliteration may be favored and is commonly used in the treatment of frontal sinus diseases. We present a case of an individual with a history of parasellar surgery for the treatment of craniopharyngioma that was complicated by a CSF leak. The leak was treated using sinus obliteration with hydroxyapatite cement. Approximately 10 years later, patient presented with right frontal cellulitis, an infected hydroxyapatite mass and empyema in the right ethmoidal and frontal sinuses. We review the outcomes of hydroxyapatite cement for frontal sinus obliteration and compare it to obliteration using autologous fat. This case highlights the increased risk of infection when hydroxyapatite is exposed to sites of bacterial contamination, such as frontal sinus mucosa.