J Rhinol.  2023 Jul;30(2):105-114. 10.18787/jr.2023.00024.

Two Cases of Frontal Sinus Inverted Papilloma Treated With a Combined Bifrontal Craniotomy and Endonasal Endoscopic Approach

• An JS
• Kim DH

• KMID: 2544620
• DOI: http://doi.org/10.18787/jr.2023.00024

Abstract

An inverted papilloma of the frontal sinus is a challenging lesion for surgeons, for both anatomical and pathological reasons. Despite the trend away from an external approach and towards an endonasal endoscopic approach, indications for an external approach remain. The options for an external approach include endoscopic frontal trephination, transpalpebral orbital craniotomy, a supraorbital transeyebrow approach, an osteoplastic flap, and bifrontal craniotomy with cranialization. Each approach has advantages and disadvantages. Deciding on the appropriate approach is important for the patient’s prognosis and risk of complications. We report two cases of frontal sinus inverted papilloma treated with a combined bifrontal craniotomy with cranialization and endonasal endoscopic approach. We also present a general review of the external approaches mentioned above.

Keyword

Papilloma, inverted; Frontal sinus; Craniotomy; Paranasal sinus diseases; Endoscopy

Figure

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  Fig. 1. Preoperative radiologic exam of case 1. Paranasal nonenhanced CT axial image (A) and coronal image (B); paranasal enhanced MRI axial T2 image (C) and coronal T1 image (D). CT, computed tomography; MRI, magnetic resonance imaging.

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  Fig. 2. Inverted papilloma involving the left frontal bullar cell in the preoperative paranasal enhanced MRI of case 1: axial T1 image (A), coronal T1 image (B), and sagittal T1 image (C). MRI, magnetic resonance imaging.

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  Fig. 3. Six-month postoperative follow-up paranasal enhanced MRI of case 1: axial T2 images (A) and coronal T1 images (B). MRI, magnetic resonance imaging.

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  Fig. 4. Preoperative sinus fiberscopy of case 2. Sinus fiberscopy image of the left frontostomy site.

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  Fig. 5. Preoperative radiologic exam of case 2. Paranasal nonenhanced CT axial image (A) and coronal image (B), and a paranasal enhanced MRI axial T2 image (C) and coronal T2 image (D). CT, computed tomography; MRI, magnetic resonance imaging.

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  Fig. 6. Intraoperative pictures of case 2. A: Frontal craniotomy state after bicoronal incision and galeal flap harvest. B: Reattached frontal cranium using miniplates and screws (Jeil Medical, Leforte Neuro system 14-NL-004, NL-BR-040, Seoul, South Korea). C: Detached frontal bone. D: Suspicious invasion site removed from detached frontal cranium.

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  Fig. 7. Two-year postoperative follow-up paranasal enhanced MRI of case 2: axial T2 image (A) and coronal T2 image (B). MRI, magnetic resonance imaging.

Reference

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