gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Frontal skull base (pseudo-)mucocele – delayed complications after head injuries

Frontobasale (Pseudo-)Mukozelen – späte Komplikationen nach Schädel-Hirn-Traumata

Meeting Abstract

  • corresponding author B. Fischer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • A. Jeibmann - Institut für Neuropathologie, Universitätsklinikum Münster
  • H. Wassmann - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • D. Moskopp - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.08.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Fischer et al.
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Objective: Patients with blunt or penetrating injuries of the frontal skull basedo not always present neurological deficits. In some of them, especially in the time before computer tomography (CT) and magnetic resonance imaging (MRI), the extent of injury and possible intracranial foreign bodies were not revealed by imaging techniques and the injury was not diagnosed as such. We report on our experience with 5 patients with frontal (pseudo-)mucoceles, which occurred up to 46 years after initial injury, differences in symptomatology, surgical treatment, intraoperative findings, results of microbiological examinations and clinical outcome.

Methods: In a retrospective study (last decade) of our internal database, 5 male patients with a late onset of a (pseudo-)mucocele after head injury were identified. Mean duration between initial injury and diagnosis was about 28.6 years (range: 14 to 46 years). All patients were treated initially in emergency departments and 3 of them with reconstruction of frontal skull base; in 1 patient only the external part of a foreign wooden body had been resected, without neuroimaging evaluation. In the 5th patient, the orbital roof as well as the eyeball were damaged by a blunt trauma and needed to be enucleated and replaced by a prosthesis at the same time. All patients with secondary symptoms were admitted with swelling of the eyelid, protrusion of the eyeball or dislocation of the eye prosthesis (5th patient).

Results: Reconstructive surgery of the frontal skull base was performed by removing the foreign bodies and mucoceles, cranialization and exenteration of the frontal sinus, subsequently covering it with a periosteal flap or fascia lata. During operation encapsulated wooden fragments were found in 2 patients. of Extensive microbiological examinations the foreign bodies as well as from the mucoceles were carried out. Only in one patient with a mucocele and the shortest period after injury (14 years) was Staphylococcus aureus found. In all patients broad spectrum antibiotic therapy was administered for 2 weeks. After a follow-up period of 3.4 years, no new mucocele or local infection was seen.

Conclusions: The best strategy for preventing the delayed onset of post-traumatic (pseudo-)mucocele formations consists of initial adequate neuroimaging techniques and an excellent first surgical performance. Nowadays every patient with suspected blunt or penetrating orbito-cranial injury and/or fracture of the frontal sinus should have a cranial CT with reconstruction. Furthermore, if surgery is necessary, resection of necrosis and foreign bodies as well as reconstruction of the frontal skull base should definitely be performed in one session.