Non-malignant lesions involving the paranasal sinuses and anterior skull base

Abstract

Background and objectivesLesions involving the paranasal sinuses and the anterior cranial base at the same time are not unusual. These diseases have different features. The aim of this study is to set out the particularities of the non-malignant lesions involving both zones. Material and methodsRetrospective study of 32 patients between 1986 and 2007 diagnosed with: non-malignant tumours (31.2%), tumour-like lesions (3.1%), fibrous-osseous lesions (12.5%), congenital or acquired malformations (18.7%), and infectious diseases (34.3%). We analyse the diagnostic imaging, the treatment, and the pathogen mechanism. ResultsOnly 6 of 43 osteomas involved the paranasal sinuses and anterior cranial fossa (13.04%): 3 cases have developed meningitis and 1 developed a pneumocephalus. Two cases are meningiomas: 1 was asymptomatic and the other one caused destruction of the subtotal frontal bone. A giant haemangioma associated with Klippel-Trenaunay syndrome is treated by combined craniofacial approach. The fibrous-osseous lesions were specifically fibrous dysplasia and affected the ethmoides. The encephalocele were predominating in the malformations group, 2 were diagnosed after repeated meningitis. Eleven cases are inclluded by infection: 10 cases caused osteomyelitis and the eleventh is a patient with a mucormycosis. Surgery has been used in 84.3% of the cases: frontal craniotomy 37%, combined craniofacial approach 18.5%, sub-frontal approach 18.5%, osteoplastic technique 18.5%, lateronasal approach 3.7%, endonasal microscopic resection 3.7%. ConclusionsIn this study the diagnosis, extension, and surgical management were supported in the imaging. A closed separation between the anterior cranial fossa and the sinus is necessary after the resection. The reconstruction was performed using a pedicled pericranial flap and titanium mesh in most of the cases.