A Case of Frontoethmoidal Mucopyocele Combined with Cerebrospinal Fluid Leak and Complicated Tension Pneumocephalus after Marsupialization

Seok-Hyun Kim; Jaehoon Jung; Sue Jean Mun; Hwan-Jung Roh

doi:10.18787/jr.2018.25.1.38

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Kim, Jung, Mun, and Roh: A Case of Frontoethmoidal Mucopyocele Combined with Cerebrospinal Fluid Leak and Complicated Tension Pneumocephalus after Marsupialization

Case Report

Journal of Rhinology 2018; 25(1): 38-42.

Published online: 31 May 2018

DOI: https://doi.org/10.18787/jr.2018.25.1.38

A Case of Frontoethmoidal Mucopyocele Combined with Cerebrospinal Fluid Leak and Complicated Tension Pneumocephalus after Marsupialization

Seok-Hyun Kim, MD, Jaehoon Jung, MD, Sue Jean Mun, MD, Hwan-Jung Roh, MD, PhD

Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

Corresponding author (rohhj@pusan.ac.kr)

Received 17 May 2016 Revised 15 August 2017 Accepted 9 January 2018

Journal of Rhinology

Abstract

After the trauma of frontoethmoidal sinus, post-traumatic mucocele may occur. Surgical removal of the lesions rarely produces cerebrospinal fluid (CSF) leakage and even delayed tension pneumocephalus. We experienced a case of fronto-ethmoid mucocele complicated with peri-operative CSF leakage and post-operative tension pneumocephalus which was improved by conservative treatment. It is imperative to take into account the potential for tension pneumocephalus when a patient suffers from severe headache after sinus surgery.

Keywords: Frontal sinus, Ethmoid sinus, Mucocele, Cerebrospinal fluid leak, Pneumocephalus

Figures and Tables

Fig. 1

Preoperative images. Brain MRI axial images show right frontoethmoidal homogenous lesion with high signal intensity (SI) on T1 weighted image (WI) (A) and intermediate SI on T2 WI (B). Non-enhanced paranasal sinus (PNS) CT shows of right frontoethmoidal sinus expansile lesion with erosion of lamina papyracea which is mildly compressing the superior oblique muscle on axial image (C) and broken lateral lamella (arrowhead) on coronal image (D).

Fig. 2

Intraoperative endoscopic findings. The pus inside the mucocele is removed (A). Cerebrospinal fluid (CSF) leakage is observed at lateral lamella (B). CSF leakage site is repaired with perpendicular plate of ethmoid bone (C).

Fig. 3

The 10th postoperative images. Brain MRI T1 WI show pneumocephalus at frontal convexity compressing right frontal lobe, a left midline shift of brain and mild meningeal enhancement on axial (A) and coronal (B) image. Post-contrast PNS CT shows air collection at right frontotemporal region and a small bony defect at lateral lamella on axial (C) and coronal (D) image.

Fig. 4

The 15th and 23rd postoperative images. The 15th axial brain CT shows decreased air collection at frontal region and corrected midline shift (A). The 23rd axial brain CT shows no air collection at frontal region (B).

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