Toward a more rationalized use of a special technique for repair of frontal air sinus after cerebral aneurysm surgery: The most effective technique

• This is a report of the most effective technique for frontal air sinus reconstruction.
• Craniotomy passes through the frontal sinus often results in post-operative complications.
• Frontal mucosa suturing and proving the patency of nasofrontal duct are keys of treatment.
• Abdominal fat graft enhances the healing process of frontal sinus reconstruction.

A craniotomy that passes through the frontal air sinus (FAS) often results in postoperative complications such as infection, cerebrospinal fluid leakage or mucocele formation. A good understanding of FAS reconstruction can decrease the morbidity rate of complications. This study describes the outcomes of treatment and establishes the most effective technique for FAS reconstruction in our institution. We enrolled 107 patients who had a bifrontal craniotomy which exposed the FAS during the operation for an anterior communicating artery (ACoA) aneurysm. Demographic data including the follow-up information were collected and analyzed. The complications after surgery were observed and described in the treatment procedure. The patency of the nasofrontal outflow tract (NFOT) was proved by removal of blood clots and bone dust by irrigation and by direct inspection under a microscope before closure of the frontal sinus mucosa with a monofilament non-absorbable 7/0 material suture. The dura was closed in a watertight fashion and an abdominal fat graft was packed into the FAS cavity. There were 33 male and 74 female patients and the mean age (range) was 64 years (32–90 years). The mean follow-up time was 13 months (1–35 months) and complications were found in only 2 patients. One patient suffered from dislocation of the fat graft and the other patient developed a surgical wound infection. At post-operation the first patient sneezed several times and the second patient suffered from trauma in the nasal area after discharge to home. Both patients were surgically treated and cured. In conclusion, FAS reconstruction from our technique is very effective for the prevention of complications after bifrontal craniotomy. Direct suturing of the frontal sinus mucosa and proving the patency of the NFOT are keys to successful treatment.