Effect of DuraGen on closure of widely opened frontal sinus with duralplasty in the management of resection of schwannoma in the anterior cranial Fossa: A case report and review of literature

Abstract

Background: Reconstruction the skull base defect of an widely opened frontal sinus following extensive tumor resection in the anterior cranial fossa needs to be addressed to prevent postoperative cerebrospinal fluid (CSF) leakage or tension pneumocephalus. Case description: A 51-year-old man presented with headache and epileptic seizure. Magnetic resonance imaging (MRI) showed a cystic and solid extra-axial tumor with homogenous enhancement adhering the planum sphenoidale. Since the frontal sinus was widely opened following gross total resection of the tumor, the sinus was filled and covered with the adipose tissue. Thereafter, DuraGen overlaid the adipose tissue and was covered with the vascularized pericranium. Additionally, the edge of the pericranium flap was sutured to the dura, and further DuraGen overlaid by “sandwich” technique to protect against CSF leakage and tension pneumocephalus. Three months after operation, CT revealed that complete obliteration of the frontal sinus was confirmed and neither CSF leakage nor meningitis were observed. Conclusion: The present study demonstrated that closure of the widely opened frontal sinus using DuraGen inserted between the skull and the pericranium flap is an effective and promising method for the frontal sinus isolation. Keywords: DuraGen, Anterior cranial fossa, Frontal sinus, Skull base surgery, Duraplasty, Cerebrospinal fluid leakage