Bifrontal Osteoplastic Flap: An Option to Decrease Infection in Bifrontal Craniotomies with Skull Base Osteotomies.

Michael Ortiz Torres,Endrit Ziu,Steven B Carr,N Scott Litofsky,Samiat Agunbiade

doi:10.3390/brainsci12020163

Michael Ortiz Torres, Endrit Ziu + Show 3 more

Open Access

https://doi.org/10.3390/brainsci12020163

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Journal: Brain sciences	Publication Date: Jan 26, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: University of Missouri

Abstract

Infection can be a common complication following bifrontal craniotomy with skull base osteotomies given the potential violation of sinuses and entry into the nasal structures. Our objective was to examine our series of patients who underwent a bifrontal craniotomy with skull base osteotomies and describe the infection rate. We propose the bifrontal osteoplastic flap as an adjunct to infection prevention. A retrospective single-center study of a patient database was performed. Twenty patients were identified. Fifty-five percent were male. The mean age was 55.7 ± 13.9 years. The most common indications for surgery were esthesioneuroblastomas (35%) and anterior skull base meningiomas (30%). Six patients (30%) developed an infection, 1 patient (5%) developed a CSF leak, and no patients developed a mucocele. All 6 infected cases had nasal pathology with intracranial extension, they all received chemoradiation post-operatively and were all combined cases with otorhinolaryngology. Eighty-three percent of these patients required a craniectomy and all of them required long-term IV antibiotics. Infection is not uncommon after a bifrontal craniotomy with skull base osteotomies and the use of the bifrontal osteoplastic flap in cases where the risk of infection is high, i.e., esthesioneuroblastomas surgery, may help reduce said risk and lead to better patient outcomes.

Highlights

Lesions of the anterior cranial fossa floor, including benign and malignant primary or secondary tumors, cerebrospinal fluid fistulas, encephaloceles and other skull base defects, are often approached through a bifrontal craniotomy, with or without a skull base osteotomy, such as a cribriform osteotomy
When a durotomy at the cribriform plate is performed, a cerebrospinal fluid (CSF) leak can occur, which leads to the potential for developing a post-operative mucocele or an infection [4]
We reviewed our series of patients who underwent bifrontal craniotomies with skull base osteotomies for skull base lesions or skull base repair with the aim of describing the overall rate of complications, infections

Summary

Introduction

Lesions of the anterior cranial fossa floor, including benign and malignant primary or secondary tumors, cerebrospinal fluid fistulas, encephaloceles and other skull base defects, are often approached through a bifrontal craniotomy, with or without a skull base osteotomy, such as a cribriform osteotomy. The exposure provides a generous corridor for the management of such midline lesions, regardless of size [1]. The frontal sinuses are entered, which creates a clean contaminated surgical field. With cribriform osteotomies, the ethmoid sinuses are exposed, which contributes to the contaminated field. The contaminated field increases the risk of infection [2,3]. When a durotomy at the cribriform plate is performed, a cerebrospinal fluid (CSF) leak can occur, which leads to the potential for developing a post-operative mucocele or an infection [4]

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