Management of frontoethmoidal osteoma causing pneumocephalus and cerebrospinal fluid leakage with minimally invasive techniques: illustrative cases

• Published in: Journal of neurosurgery. Case lessons Vol. 7; no. 6
• Main Authors: Candy, Nicholas G, Wu, Kyle C, Finger, Guilherme, VanKoevering, Kyle, Prevedello, Daniel M
• Format: Journal Article
• Language: English
• Published: United States American Association of Neurological Surgeons 05-02-2024
• Subjects: Case Lesson; pneumocephalus; skull base neoplasm; case series; osteoma; cerebrospinal fluid rhinorrhea
• ISSN: 2694-1902; 2694-1902
• DOI: 10.3171/CASE23699

Osteoid osteoma is a common benign bone tumor frequently seen in the frontoethmoid region. However, involvement of the skull base is rare, with few cases previously reported.
The authors report two cases of spontaneous, symptomatic frontoethmoidal osteoma: one presented with neurological deficit secondary to tension pneumocephalus and the other with cerebrospinal fluid leakage. The first case was managed with a transfrontal sinus craniotomy and pneumocephalus decompression with osteoma resection and skull base reconstruction. The second case was managed with a uninaral endoscopic endonasal approach to the anterior skull base with osteoma resection and reconstruction.
Given the paucity of cases with associated tension pneumocephalus described in the literature, it was relevant to describe the authors' experience with surgical decision-making and the expected outcomes among patients with this pathology when using minimally invasive techniques.