title: Giant frontal mucocele complicated by subdural empyema: treatment of a rare association.
abstract: Giant frontal mucocele (GFM) is an extremely rare cause of frontal lobe syndrome. Subdural empyema (SDE) is an uncommon complication of paranasal sinisutis, for which craniotomy and decompressive craniotomy are the most effective surgical procedures. A 54-year-old man was brought unconscious to the emergency room where recurrent generalized seizures occurred. Heroine abuse, HCV-related hepatitis, prolonged antibiotic therapy for treatment of purulent rhinorrhea, along with recent personality changes were reported. High white blood cell count, pansinusitis, GFM, SDE and cerebritis were documented. The patient underwent bifrontal craniotomy in emergency, extensive drilling of the inner aspect of the frontal bone, surgical toilet of the enlarged frontal sinus and its "cranialization". Prevotella intermedia and Fusobacterium nucleatum were isolated and antibiotic therapy was started intravenously and then continued orally for 3 months. 2 years later the patient has recovered, though minor signs of frontal lobe syndrome persist. To the authors knowledge, this is the first case of GFM with SDE reported in the literature. Although decompressive craniectomy is advocated in extreme conditions, as in this case, "internal decompressive craniectomy", obtained with craniotomy and cranialization of the frontal sinuses, is strongly advocated in cases of SDE associated with megasinuses.
authors.affiliation: Institute of Neurosurgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Della Pepa
authors.forename: Francesco
authors.initials: F
authors.lastname: Doglietto
authors.forename: Carlotta Ginevra
authors.initials: CG
authors.lastname: Nucci
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Fontanella
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D013354:Empyema, Subdural / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005625:Frontal Lobe / Q000473:pathology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000927:Anticonvulsants