• Satoru Takeuchi, Rokuya Tanikawa, Makoto Katsuno, Toshiyuki Tsuboi, Kosumo Noda, Junpei Oda, Shiro Miyata, Nakao Ota, and Hiroyasu Kamiyama.
• Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan; Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan. Electronic address: s.takeuchi@room.ocn.ne.jp.
• World Neurosurg. 2015 Jun 1;83(6):907-11.

BackgroundBifrontal craniotomy is effective for the treatment of anterior skull base lesions. However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid leakage and infection. We describe our procedure for maintaining the patency of the nasofrontal duct and direct suture of the exposed and violated FS mucosa.MethodsBifrontal craniotomy with reconstruction of the FS was performed in 103 patients (68 women and 35 men; age range, 32-90 years; mean age, 62.6 years) for lesions including anterior cerebral artery aneurysm (100 cases), arteriovenous fistula (1 case), and meningioma (2 cases). After opening the FS, the mucosal membrane of the FS was dissected from the FS wall, and the orifice of the FS mucosa was closed with 7-0 monofilament running sutures. The nasofrontal duct was kept open by washing thoroughly to remove any bone dust and clot in the FS. The cavity of the FS was then packed with abdominal fat.ResultsPostoperative cerebrospinal fluid leakage and mucocele formation did not occur in any patient. An intracranial infectious complication occurred in 1 patient (1.0%).ConclusionsThe present results indicate the effectiveness of our technique for the prevention of FS-related postoperative complications.Copyright © 2015 Elsevier Inc. All rights reserved.

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