This  is  a  case  of  a  47  year-old  female  presenting  with  typical Cushingoid appearance and CSF rhinorrhea. MRI revealed a 4.4 cm x 2.9 cm x 4.5 cm enhancing intranasal mass with evidence of erosion of the left cribriform extending to the left anterior cranial fossa. Dexamethasone suppression  test  yielded  elevated  cortisol  level. Endoscopic nasal biopsy done showed a round cell tumor positive for  ACTH,  synaptophysin,  chromogranin  A,  and  S-100.  Patient subsequently  underwent  endoscopic  endonasal  excision  of  left intranasal mass with creation of pericranial flap for repair of CSF leak.  This  report  is  presented  to  discuss  a  rare  case  of  ACTH secreting esthesioneurblastoma including its diagnostic challenges and surgical options for repair of anterior cranial fossa defect to address CSF leak particularly by means of a vascularized pericranial flap.

Human ; Female ; Middle Aged ; Cerebrospinal Fluid Rhinorrhea ; Cranial Fossa, Anterior ; Synaptophysin ; Chromogranin A ; Hydrocortisone ; Nose ; Endoscopy ; Surgical Flaps ; Dexamethasone ; Adrenocorticotropic Hormone

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
Brain Abscess ; Congenital Abnormalities ; Cranial Fossa, Anterior ; Debridement ; Encephalitis ; Fatal Outcome ; Frontal Bone ; Frontal Sinus* ; Meningitis ; Mucocele ; Nasal Cavity ; Osteomyelitis ; Postoperative Period ; Reoperation ; Sinusitis ; Skeleton ; Skin ; Surgeons ; Thrombosis

BACKGROUND: Craniofacial resection (CFR) has been regarded as a standard treatment for various tumors involving the anterior skull base. The purpose of this study was to evaluate the results of CFR for the patients with anterior skull base malignancies in our hospital. METHODS: We retrospectively analyzed 17 patients with anterior skull base malignancies treated with CFR between 2001 and 2012. Mean follow-up duration was 41 months (range, 2-103 months). RESULTS: Intracranial involvement was found in 11 patients (65%) and orbital extension in 6 patients (35%). Classical bifrontal craniotomy was combined with endoscopic endonasal approach in 14 patients and external approach in 3 patients. Vascularized flap was used for reconstruction of the anterior fossa floor in 16 patients (94%). The most common pathological type was squamous cell carcinoma (6 patients). Gross total resection was achieved in all cases. Postoperative complications developed in 4 patients (24%) and included local wound problem and brain abscess. One patient with liver cirrhosis died from unexpected varix bleeding after the operation. Although postoperative treatment, such as radiotherapy or chemotherapy, was performed in 14 patients, local recurrence was seen in 6 patients. The mean overall survival time after the operation was 69.0 months (95% confidence interval: 47.5-90.5 months) with a 1-, 2-, and 5-year survival rate of 82.3%, 76.5%, and 64.7%, respectively. Postoperative radiotherapy was found to be the powerful prognostic factor for favorable survival. CONCLUSION: Considering the higher local control rate and acceptable complication or mortality rate, CFR with adjuvant radiotherapy is a gold standard treatment option for malignant tumors involving anterior skull base, especially with extensive intracranial involvement.
Brain Abscess ; Carcinoma, Squamous Cell ; Cranial Fossa, Anterior ; Craniotomy ; Drug Therapy ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Liver Cirrhosis ; Mortality ; Orbit ; Paranasal Sinus Neoplasms ; Postoperative Complications ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Skull Base* ; Skull* ; Survival Rate ; Treatment Outcome ; Varicose Veins ; Wounds and Injuries

Surgery on the frontal sinus or frontal recess remains a challenge for rhinologist because of its variability and complex anatomy. Its location, relatively complex and narrow frontal recess also make visualization difficult and predispose it to stenosis. Significantly, serious complications are possible due to the anterior ethmoidal artery, orbit and anterior cranial fossa. An understanding of frontal sinus and frontal recess anatomy is essential to perform endoscopic frontal sinus surgery. This paper examines frontal sinus anatomy and then variable procedures of endoscopic frontal sinus surgery. The selection of less invasive procedure as possible after assessment of the patient's history, diagnostic endoscopy, and the CT scan makes successful endoscopic treatment of frontal sinus diseases.
Arteries ; Constriction, Pathologic ; Cranial Fossa, Anterior ; Endoscopy ; Frontal Sinus* ; Orbit ; Tomography, X-Ray Computed

Ossifying fibromas are benign fibro-osseous tumors of mesenchymal origin. Although ossifying fibromas have principally been found in the jaw, they have also been reported in the frontal, ethmoid, sphenoid, and temporal bones, as well as the orbit and anterior cranial fossa. Ossifying fibromas affecting the jaw exhibit variable behaviors ranging from slow growth to occasionally aggressive local destruction. In the present article, we discuss a differential diagnosis considered for maxillary swellings and report a rare case of ossifying fibroma occurring in the maxilla.
Bone Neoplasms ; Cranial Fossa, Anterior ; Diagnosis, Differential* ; Fibroma, Ossifying ; Jaw ; Maxilla* ; Orbit ; Temporal Bone

Cerebrospinal fluid (CSF) rhinorrhea usually occurs after a traumatic or non-traumatic head injury, as more than 80% of all cases of CSF rhinorrhea are caused by traumatic head injuries. In fact, CSF rhionorrhea is observed in 2 to 3% of traumatic head injuries, with 50% of the CSF found in the anterior cranial fossa, but mostly of them in the cribriform plate. CSF rhionorrhea can occur two days after a traumatic head injury, but it can take up to 3 months to notice the symptoms of CSF rhionorrhea in a patient with a traumatic head injury. Iatrogenic CSF rhionorrhea is usually caused by neurosurgery operation or otorhinolaryngological surgery such as sinus surgery. For example, closed reduction treating nasal bone fractures can cause CSF rhionorrhea, so patients should be watched at all times. This paper reports two cases of CSF rhionorrhea caused by closed nasal reduction.
Cerebrospinal Fluid ; Cerebrospinal Fluid Rhinorrhea* ; Cranial Fossa, Anterior ; Craniocerebral Trauma ; Endoscopes ; Ethmoid Bone ; Fractures, Closed ; Humans ; Nasal Bone ; Neurosurgery ; Surgical Flaps

Cranial Fossa, Anterior ; Humans ; Liposarcoma, Myxoid ; diagnostic imaging ; metabolism ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; S100 Proteins ; metabolism ; Skull Base Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Tomography, X-Ray Computed

Rhinocerebral mucormycosis is an acute fulminant opportunistic fungal infection usually seen in diabetic or immunocompromised patients. The fungi that cause mucormycosis inoculate the nasal mucosa and may spread to the paranasal sinuses, orbit, and brain. Our patient initially presented with mild ethmoid sinusitis. At that time, brain MRI and contrast-enhanced MR angiography were grossly normal. However, aggravation of sinusitis with extension to the right orbit and anterior cranial fossa rapidly developed within two months. Moreover, an occlusion of the right internal carotid artery was combined. We report a case of a pathologically-proven rhino-orbital-cerebral mucormycosis with serial follow-up imaging for over one year.
Angiography ; Brain ; Carotid Artery, Internal ; Cranial Fossa, Anterior ; Ethmoid Sinus ; Ethmoid Sinusitis ; Follow-Up Studies ; Fungi ; Humans ; Immunocompromised Host ; Mucormycosis ; Nasal Mucosa ; Orbit ; Paranasal Sinuses ; Sinusitis

OBJECTIVE: A dural arteriovenous fistula (DAVF) of the anterior cranial fossa is rare. We report a case of a DAVF of the anterior cranial fossa which was treated surgically, following endovascular treatment failure. METHODS & RESULTS: The subject was a 53-year-old male with a headache caused by a hematoma in the right frontal lobe. A vascular abnormality of the anterior cranial fossa was suspected on brain computed tomographic angiography. The subsequent transfemoral cerebral angiography revealed that the AVF of the anterior cranial fossa was mainly fed by the left anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was attempted. However, the procedure failed to occlude the fistula due to the existing feeding artery (the right anterior ethmoidal artery). Consequently, a surgical approach was undertaken and the lesion was successfully obliterated. CONCLUSION: We report a rare case of an intracerebral hematoma caused by a DAVF, which was successfully managed surgically following, endovascular treatment failure.
Angiography ; Arteries ; Arteriovenous Fistula ; Brain ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Cerebral Hemorrhage ; Cranial Fossa, Anterior ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Male ; Middle Aged ; Treatment Failure

OBJECTIVE: To explore the effect of modified pedicled cranial periosteum compound flap in reconstructing the defect of anterior cranial fossa complicated with cerebrospinal fluid leakage. METHOD: Seven nasal and sinus tumor cases with defects and CSF were undertaken reconstructing surgery with the flap, of which 1 was benign and the others were malignancies. The transferred flap pedicled with the frontal branch of the superficial temporal artery and complemented with ipsilateral supraorbital and/or supratraochlear artery. RESULT: All cases healed without failure, one case with adjuvant radiotherapy experienced partial free frontal bone necrosis and healed by ways of drainage through temporal incision. The inner surface of the flap in the nasal cavity was smooth. CONCLUSION Frontal cranial periosteum compound flap have some advantages, such as adequate quantity, good blood supply and easily making,so it can be choose as an important method to reconstruct the defects of anterior cranial fossa and CSF leakage.
Adult ; Aged ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Cranial Fossa, Anterior ; pathology ; Female ; Humans ; Male ; Middle Aged ; Periosteum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skull Base ; surgery ; Surgical Flaps ; Treatment Outcome