gms | German Medical Science

Introduction: Mucoceles develop after obstruction of an ostium of a paranasal sinus and after years or decades of development they cause osteolysis. Rarely this leads to destruction of the skull base. The only causal therapy is surgery. Traditionally, these procedures were performed externally.

Methods: We describe 12 cases of skull base destructing mucoceles that were operated in our department in the last years.

Results: In 10 cases endoscopic operations were performed and the mucoceles were not resected but marsupialized. Intraoperative navigation systems were used in all procedures. Defects of the sphenoid sinus were detected in 7 patients, and defects of the frontal sinus in 3 patients. One case of intraoperative CSF-leak was observed that could be reconstructed endoscopically. No postoperative complications were noted. During the follow-up period of 1–6 years, one mucocele recurrence (10 months after surgery) was recognized and once again endoscopically operated. Two patients had external operations due to a far lateral localization of the mucoceles in the frontal sinus which made an endoscopic approach technically impossible.

Conclusions: From our point of view, external approaches to skull base destructing mucoceles are only indicated if an endoscopic technique is not feasible due to the localization of the mucocele. Special attention should be given intraoperatively to a wide opening of the mucocele to avoid recurrences. Complete resection of mucoceles is not only superfluous but also counterproductive since it increases the risk of dural injury. The surgical morbidity can reduced by endoscopic approaches without increasing the frequency of complications or recurrences.