INTRODUCTION: It is well known that frontal sinusitis sometimes develops after craniotomy if frontal air sinus is opened and closed inappropriately at the craniotomy. It is controversial that the affected frontal air sinus should be cranialized, obliterated or preserved. The purpose of this study is to evaluate our method of sinus preservation.

MATERIALS & METHODS: From 1998 to 2006, we treated ten cases of frontal sinus complications which have developed more than one month after craniotomy. An initial finding of every case was skin fistula with purulent discharge. Infection developed more than 1 year after craniotomy in seven cases. And in the other three cases infection developed a few months after craniotomy. At first surgery, debridement and sinus preservation with frontalis-pericranial flap was performed. At second surgery, cranioplasty with hydroxyapatite ceramic implant was performed. Mean follow-up range was 42 months (range: 4 to 84 months).

RESULTS: Preoperative CT scan showed soft tissue density of affected frontal sinus in every case. Inflammation induced by bone wax seemed the main cause of frontal sinusitis in every case.Eight cases showed uneventful postoperative course. Two cases showed recurrence of infection within a few months. In one of the two cases with recurrence of infection, the frontal sinus was obliterated with temporalis muscle flap. This case showed uneventful course after the frontal sinus obliteration. The other case was managed conservatively.

CONCLUSION: The results reported here with preservation method showed relatively good results. However, nasofrontal duct is likely to become narrow or obstructed spontaneously in the case of more than 10 years after craniotomy. And we should choose sinus obliteration or cranialization in such a case with recurrence of infection after sinus preservation.
View Synopsis (.doc format, 2882.0 kb)