title: A rare case of recurrent frontal osteoma complicated by mucopyocele with an unusual organism, Moraxella catarrhalis.
abstract: OBJECTIVE
  We report a rare case of recurrent frontal osteoma complicated by mucopyocele and intracranial abscess. Furthermore, we report an unusual organism, Moraxella catarrhalis, as the infectious agent. Finally, we demonstrate that endovascular embolization may be part of the treatment paradigm of frontal osteomas in selected cases.
  
  
  METHODS
  A 71-year-old man with a previous history of craniotomy presented to the emergency room with 24 hours of headache episodes, confusion, lethargy, and spells of low-grade fever. Imaging and angiography revealed a complex frontal lesion involving the frontoethmoidal sinuses that extended into the medial orbit and anterior skull base with multiple feeding vessels from the middle meningeal artery. The initial diagnosis of recurrent meningioma was made based on imaging data. The patient underwent partial angiographic embolization of the lesion followed by microneurosurgical complete resection. Pathology revealed a synchronous presentation of an osteoma and mucopyocele with intracranial abscess caused by M. catarrhalis.
  
  
  CONCLUSIONS
  Synchronous presentation of a frontal osteoma with mucopyocele is a rare event. However, the case of a recurrent osteoma complicated by infection with M. catarrhalis has not been reported in the literature, nor a treatment paradigm that included preoperative partial endovascular embolization.
authors.affiliation: Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Ramakrishna
authors.affiliation: Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA.
authors.forename: M Nathan
authors.initials: MN
authors.lastname: Nair
authors.affiliation: Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Huber
authors.affiliation: Departments of Neurological Surgery and Pathology, University of Washington, Seattle, Washington, USA. Electronic address: lsekhar@u.washington.edu.
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
mesh_terms: D000368:Aged; D001922:Brain Abscess / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005094:Exophthalmos / Q000150:complications; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000473:pathology; D001936:Moraxella catarrhalis; D045828:Moraxellaceae Infections / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D009078:Mucocele / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D010016:Osteoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed