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J Neurol Surg B Skull Base 2024; 85(02): 119-122
DOI: 10.1055/a-2015-8371
Original Article

Frontal Sinus Mucosa Bacteriological Features: Evaluation after Unintentional Opening in Neurosurgery

Hiroki Sato
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
2   Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
,
Hidetoshi Ooigawa
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
2   Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
,
Kaima Suzuki
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
2   Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
,
Taro Yanagawa
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
,
Milan Lepic
2   Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
,
Munehiro Otsuka
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
,
Goji Fushihara
1   Department of Neurosurgery, Saitama Cardiovascular and Respiratory Center, Itai, Kumagaya, Saitama, Japan
,
Hiroki Kurita
2   Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
› Author Affiliations Funding The second author, Hidetoshi Ooigawa, received financial support for the conduct of the research from the research fund of the Saitama Cardiovascular and Respiratory Center. The funding source was not involved in this study design.
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Abstract

Objectives The bacteriological features of the frontal sinus mucosa may impose significant complications in neurosurgery, when breached unintentionally. This study aimed to investigate the bacterial flora in patients undergoing frontal craniotomy for cerebrovascular substrate surgery.

Design This is a single-center prospective study.

Setting When mucosal laceration occurred, the patients underwent frontal sinus reconstruction with mucosa reconstruction, preserving the nasofrontal duct.

Participants We enrolled eight consecutive patients who underwent bifrontal craniotomy associated with frontal sinus mucosa laceration.

Main Outcome Measures A portion of the mucosa was extracted during the reconstructive procedure and was sent for microbiological analysis.

Results None of the patients presented with the bacterial flora in the mucosal cultures. No patient experienced postoperative cerebrospinal fluid leakage or meningitis. One patient with a clinical history of chronic maxillary sinusitis presented with a subcutaneous abscess around the forehead at 9 months postoperatively. The patient rapidly recovered after receiving oral administration of antibiotics.

Conclusions Our findings demonstrated that the frontal sinuses were maintained in an aseptic environment in all cases. The results may encourage the development and wider use of transfrontal sinus approaches.

Keywords

frontal sinus - injury - bifrontal approach - craniotomy - complication


Publication History

Received: 26 August 2022

Accepted: 09 January 2023

Accepted Manuscript online:
19 January 2023

Article published online:
20 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Siedlecki Z, Sabramowicz M, Woźniak J. et al. Extent of the frontal sinuses in the aspect of neurosurgical craniotomy approaches. Folia Morphol (Warsz) 2022; 81 (04) 1047-1053
    CrossrefPubMedGoogle Scholar
  • 2 Flanigan P, Kshettry VR, Mullin JP, Jahangiri A, Recinos PF. Frontal sinus morphometry in relation to surgically relevant landmarks in the United States population. World Neurosurg 2016; 91: 12-15
    CrossrefPubMedGoogle Scholar
  • 3 Abou-Hamad W, Matar N, Elias M. et al. Bacterial flora in normal adult maxillary sinuses. Am J Rhinol Allergy 2009; 23 (03) 261-263
    CrossrefPubMedGoogle Scholar
  • 4 Brook I. Aerobic and anaerobic bacterial flora of normal maxillary sinuses. Laryngoscope 1981; 91 (03) 372-376
    CrossrefPubMedGoogle Scholar
  • 5 Cook HE, Haber J. Bacteriology of the maxillary sinus. J Oral Maxillofac Surg 1987; 45 (12) 1011-1014
    CrossrefPubMedGoogle Scholar
  • 6 Jiang RS, Liang KL, Jang JW, Hsu CY. Bacteriology of endoscopically normal maxillary sinuses. J Laryngol Otol 1999; 113 (09) 825-828
    CrossrefPubMedGoogle Scholar
  • 7 Sobin J, Engquist S, Nord CE. Bacteriology of the maxillary sinus in healthy volunteers. Scand J Infect Dis 1992; 24 (05) 633-635
    CrossrefPubMedGoogle Scholar
  • 8 Meetze K, Palmer JN, Schlosser RJ. Frontal sinus complications after frontal craniotomy. Laryngoscope 2004; 114 (05) 945-948
    CrossrefPubMedGoogle Scholar
  • 9 Murai Y, Mizunari T, Kobayashi S, Teramoto A. Surgical technique for the prevention of cerebrospinal fluid leakage after bifrontal craniotomy. World Neurosurg 2014; 81 (02) 344-347
    CrossrefPubMedGoogle Scholar
  • 10 Schramm Jr VL, Maroon JC. Sinus complications of frontal craniotomy. Laryngoscope 1979; 89 (9 Pt 1): 1436-1445
    CrossrefPubMedGoogle Scholar
  • 11 Takeuchi S, Tanikawa R, Katsuno M. et al. An effective method of frontal sinus reconstruction after bifrontal craniotomy: experience with 103 patients. World Neurosurg 2015; 83 (06) 907-911
    CrossrefPubMedGoogle Scholar
  • 12 Yasui N, Nathal E, Fujiwara H, Suzuki A. The basal interhemispheric approach for acute anterior communicating aneurysms. Acta Neurochir (Wien) 1992; 118 (3–4): 91-97
    CrossrefPubMedGoogle Scholar
  • 13 Farmer J. The Paranasal Sinuses: Neurosurgical Considerations. 2nd ed. vol 1. Neurosurgery. McGraw-Hill Health Professions Division; 1996: 588-590
    Google Scholar
  • 14 Ciporen J, Lucke-Wold B, Gillham H, Cua D, Kim J, Akins P. Paramedian forehead flap for repair of refractory high-flow anterior skull base CSF leak. Turk Neurosurg 2017; (e-pub ahead of print). DOI: 10.5137/1019-5149.JTN.20662-17.1.
    CrossrefPubMedGoogle Scholar
  • 15 Miller C, Weisbrod L, Beahm D, Chamoun R. Compartmentalization: an open technique for frontal sinus repair and preservation-description of technique and early case series. J Neurol Surg B Skull Base 2021; 82 (02) 189-195
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y. Etiology and outcome of community-acquired lung abscess. Respiration 2010; 80 (02) 98-105
    CrossrefPubMedGoogle Scholar
  • 17 Albu S, Florian IS. Bacteriology of normal frontal sinuses. Am J Otolaryngol 2013; 34 (04) 327-330
    CrossrefPubMedGoogle Scholar
  • 18 Winther B, Gwaltney J. Microbiology of chronic frontal sinusitis. In: Kountakis SE, Senior BA, Draf W, eds. The Frontal Sinus. Springer-Verlag; 2005: 53-57
    Google Scholar
  • 19 Daniels DL, Mafee MF, Smith MM. et al. The frontal sinus drainage pathway and related structures. AJNR Am J Neuroradiol 2003; 24 (08) 1618-1627
    PubMedGoogle Scholar
  • 20 Dineen P. The effect of oxidized regenerated cellulose on experimental infected splenotomies. J Surg Res 1977; 23 (02) 114-125
    CrossrefPubMedGoogle Scholar
  • 21 Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect (Larchmt) 2003; 4 (03) 255-262
    CrossrefPubMedGoogle Scholar