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Intradural extension of mucocele secondary to giant frontal sinus osteoma: Diagnostic pitfalls
Sundus Ali1, Adnan Qasim1, Bilal Anwar2
1Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Punjab, Pakistan.
Background:
Paranasal sinus osteoma in association with intracranial mucocele is a rare entity while intradural extension is even rarer. Our aim of presenting this case is to highlight the diagnostic pitfalls and reiterate the importance of prompt treatment of expected complications.
Case Description:
A 35-year-old known epileptic, for the past 5 years, presented with altered sensorium for the past 2 days. Computed tomography (CT) of the brain plain showed ventriculomegaly and cystic lesion in the left frontal lobe adjacent to a calvarial osteoma. A ventriculoperitoneal (VP) shunt was done which resulted in tension pneumocephalus and led us to discover the origin of osteoma from the left frontal sinus on CT functional endoscopic sinus surgery (FESS) protocol. He underwent left frontal craniotomy. The osteoma and mucocele were excised completely and watertight primary dural closure was done. Postoperative meningitis was treated with antibiotics according to the culture report.
Conclusion:
Intracranial extension of mucocele led to meningitic hydrocephalus, prompting us for VP shunt. Resulting tension pneumocephalus revealed what was missed on preop CT, a small pocket of air adjacent to osteoma intracranially. Therefore, this case underscores the importance of obtaining a preoperative CT FESS to elaborate the origin of osteoma, thus planning approach differently.
Insights
A rare case of paranasal sinus osteoma with intracranial mucocele extension highlights diagnostic challenges. Preoperative CT with functional endoscopic sinus surgery (FESS) protocol is crucial for surgical planning.
Area of Science:
- Neurosurgery
- Otolaryngology
- Radiology
Background:
- Paranasal sinus osteomas with intracranial mucoceles are rare.
- Intradural extension of these lesions is exceptionally rare.
- Prompt diagnosis and treatment are vital to manage potential complications.
Observation:
- A 35-year-old epileptic presented with altered sensorium.
- Initial CT revealed ventriculomegaly and a cystic lesion adjacent to a calvarial osteoma.
- A ventriculoperitoneal shunt led to tension pneumocephalus, revealing the osteoma's frontal sinus origin.
Findings:
- Intracranial mucocele extension caused meningitic hydrocephalus, necessitating a VP shunt.
- Tension pneumocephalus identified an intracranial air pocket missed on initial CT.
- Surgical excision of osteoma and mucocele with dural closure was performed.
Implications:
- This case emphasizes the diagnostic pitfalls in managing paranasal sinus osteomas with intracranial extension.
- Preoperative CT using a functional endoscopic sinus surgery (FESS) protocol is essential for accurate localization and surgical planning.
- Early identification and intervention can prevent severe complications like meningitis and hydrocephalus.
