Is there still a role for cranialization in modern sinus surgery?

Area of Science:

• Neurosurgery
• Otolaryngology
• Head and Neck Surgery

Background:

• Cranialization of the frontal sinuses is a surgical technique with established indications.
• Recent literature provides updated insights into its application for various frontal sinus pathologies.

Purpose of the Study:

• To review current literature on the indications and utilization of frontal sinus cranialization.
• To assess recent trends and evidence regarding conservative management versus cranialization.

Main Methods:

• Systematic review of recently published literature.
• Analysis of studies focusing on frontal sinus fractures, inflammatory conditions, and tumors.

Main Results:

• A conservative approach is now favored for frontal sinus fractures, with observation often leading to successful outcomes.
• Endoscopic sinus surgery advancements allow management of posterior table fractures without cranialization.
• Severe inflammatory conditions, including giant mucoceles, can be managed endoscopically, often avoiding cranialization.
• Benign tumors are typically resected endoscopically; however, cranialization is crucial for oncologic resections of malignant tumors with extensive dural defects.

Conclusions:

• Cranialization remains indicated in specific clinical scenarios.
• A less invasive approach is recommended for frontal sinus fractures due to comparable outcomes and reduced morbidity.
• Endoscopic techniques are effective for managing inflammatory sinus disease, often obviating the need for cranialization.
• Frontal sinus cranialization is a key component in reconstructing defects after malignant tumor resection.