title: Frontoethmoid osteoma with pneumocephalus: options for surgical management.
abstract: Pneumocephalus is an exceedingly rare complication associated with neurological deficit in cases of frontoethmoid osteoma. The overarching management strategy for affected patients remains undefined. We describe the case of a 61-year-old female patient presenting with frontoethmoid osteoma manifesting as profound intraparenchymal pneumocephalus and associated neurological deficit, treated through a minimally invasive combined surgical strategy involving image-guided burr hole decompression of the pneumocephalus followed by transnasal endoscopic removal of the tumor. Using this approach, the patient rapidly recovered full neurologic function. We review the existing literature and, given the likely intraparenchymal location of pneumocephalus associated with these lesions with the potential of rapid clinical deterioration, recommend aggressive surgical management. Although these lesions can be removed from a purely endoscopic approach, we recommend burr-hole decompression of the pneumocephalus as an adjunct to ensure prompt resolution of the neurologic symptoms.
authors.affiliation: Department of Neurosurgery, University of Colorado, Aurora, Colorado 80045, USA.
authors.forename: Yasu
authors.initials: Y
authors.lastname: Harasaki
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Pettijohn
authors.forename: Allen
authors.initials: A
authors.lastname: Waziri
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000601:surgery*; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D005626:Frontal Sinus / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010016:Osteoma / Q000150:complications / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000150:complications / Q000601:surgery*; D011007:Pneumocephalus / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome