Related Experiment Video
Updated: Jun 21, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Combined supraciliary and endoscopic endonasal approach for resection of frontal sinus mucoceles: technical note
J Knopman1, D Sigounas, C Huang
1Weill Cornell Brain Tumor Center, Department of Neurological Surgery, Weill Medical College of Cornell University, New York 10065, USA.
Objective:
Mucoceles are progressive, slow-growing lesions of the paranasal sinuses that, left untreated, can erode into surrounding structures. Complete obliteration and exenteration of the frontal sinus via a bicoronal skin incision and frontal craniotomy is the standard neurosurgical approach to treat these lesions.
Technique:
We describe two patients who underwent a combined supraciliary "keyhole" craniotomy and endonasal endoscopic resection of mucoceles with frontal sinus obliteration. The technique takes advantage of a smaller incision, while preserving adequate visualization and the ability for surgical instrumentation. Through the craniotomy, the frontal sinus mucosa is fully exenterated, the posterior table of the sinus is removed to establish communication with the intracranial space, and the nasal frontal ducts are packed with autologous tissue. The endoscopic endonasal route allows a minimally invasive access to the frontal nasal duct to ensure its blockage from the intracranial compartment. Additionally, the endoscope can be used from above through the supraciliary approach to allow for contralateral frontal sinus exposure and mucosal exenteration.
Conclusion:
The combined supraciliary-endoscopic endonasal approach provides a minimally invasive access for the treatment of sinonasal disease with frontal sinus mucoceles that invade the intracranial cavity.
Insights
This study presents a minimally invasive technique for treating frontal sinus mucoceles. The combined supraciliary-endoscopic approach offers effective surgical management for these complex sinonasal lesions.
Area of Science:
- Neurosurgery
- Otolaryngology
- Endoscopic Sinus Surgery
Background:
- Frontal sinus mucoceles are slow-growing lesions that can erode surrounding structures.
- The standard treatment involves a bicoronal incision and frontal craniotomy for sinus obliteration and exenteration.
Observation:
- A novel combined supraciliary keyhole craniotomy and endonasal endoscopic resection technique was utilized.
- This approach allows for a smaller incision while maintaining surgical visualization and instrumentation access.
Findings:
- The technique involves complete frontal sinus mucosal exenteration and posterior table removal via craniotomy.
- Endoscopic endonasal access ensures blockage of the nasal frontal ducts from the intracranial compartment.
- Contralateral frontal sinus exposure and mucosal exenteration can be achieved using the endoscope through the supraciliary approach.
Implications:
- The combined approach offers a minimally invasive alternative for treating sinonasal disease, specifically frontal sinus mucoceles invading the intracranial cavity.
- This technique potentially reduces surgical morbidity associated with traditional open approaches.
- Further research may explore the long-term outcomes and broader applicability of this combined surgical method.
