Intracranial Mucocele Formation in the Context of Longstanding Chronic Rhinosinusitis: A Clinicopathologic Series and Literature Review

Abstract

Chronic rhinosinusitis (CRS) can lead to serious long-term adverse sequelae, particularly if left untreated. The aim of this study was to describe a series of intracranial mucoceles (ICMs) that arose in the context of longstanding CRS combined with a review of the pertinent literature. A retrospective chart review was performed on all patients who developed ICMs in association with CRS between 2003 and 2012. The clinical presentation, radiographic features, surgical approach, intraoperative findings, and patient outcome were examined in the context of a literature review. Sixty-five cases of mucoceles were identified in patients with a history of CRS, of which seven (10.8%) were intracranial. Five patients were men and two were women with a mean age of 42.1 years. Headache, facial pressure, retro-orbital pain, and visual disturbances were the most common presenting symptoms. Five of the seven had previously undergone sinonasal surgery. Imaging studies showed ICMs involving the anterior cranial fossa, two of which were bilateral. Latency between onset of CRS and ICM detection ranged from 3 to 19 years (mean, 9.4 years). All patients underwent endoscopic transnasal drainage with three also requiring a concurrent, open neurosurgical procedure to access the intracranial component. There were no postoperative complications, and no recurrences were observed after a mean follow-up of 2.7 years. ICMs presenting as delayed complications of CRS are uncommon and constitute a surgical challenge. Open, external skull base approaches used in conjunction with transnasal endoscopic drainage procedures may be necessary to achieve successful management of this rare condition.

Aktueller Stand der endonasalen Nasennebenhöhlenchirurgie

“…Ungünstige Anatomie, seitliche Lokalisation oder ausgeprägte Vernarbung und Osteoneogenese können auch heute Indikationen zu einem externen oder kombinierten Vorgehen bei Stirnhöhlenmukozelen sein [819,823,824]. Eine intrakranielle Ausdehnung ist selten und erfordert in Abhängigkeit von der Ausdehnung und einer etwaigen Duraläsion ein zusätzliches externes Vorgehen [828]. Kieferhöhlenmukozelen werden seltener, da die Caldwell-Luc-Operation, die eine häufige Ursache postoperativer Kieferhöhlenmukozelen darstellt, kaum noch durchgeführt wird.…”

Partial resolution of chronic unilateral sinonasal obstructive disease in a cat using a temporary polyvinylchloride stent

“…It is theorised in this case that the cat’s unilateral sinonasal obstruction and frontal bony swelling occurred secondary to chronic rhinosinusitis (CRS), a known cause in humans. 1 In this case report, the cat had a long 2-year history of left-sided nasal discharge from a young age and previous testing for FIV/FeLV and Cryptococcus species was negative. Blindly obtained endoscopic nasal biopsies were also consistent with marked neutrophilic and lymphoplasmacytic ulcerative rhinitis.…”

Giant frontal mucocele presenting with displacement of the eye globe

“…Frontal sinus mucocele is the most common site of mucoceles; Lee et al. [5] reported that the frontal and ethmoid sinuses are the most common sinuses affected by mucoceles.…”