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. 2011 Mar;21(2):71-4.
doi: 10.1055/s-0030-1261267.

Intraoperative transillumination to determine the extent of frontal sinus in subcranial approach to anterior skull base

Rajeev Sharan, Krishnakumar Thankappan, Subramania Iyer, Dilip Panicker, Moni Abraham Kuriakose

Intraoperative transillumination to determine the extent of frontal sinus in subcranial approach to anterior skull base

Rajeev Sharan et al. Skull Base. 2011 Mar.

Abstract

We sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium plate. A total of 58 patients had undergone craniofacial resection from January 2004 to December 2007. In 13 patients, a subcranial approach was employed using the transillumination technique. Transillumination was successful in delineating the frontal sinus periphery in all 13 patients. Intraoperative transillumination of the frontal sinus through the superomedial orbital wall is a simple and effective method to delineate the frontal sinus periphery in a subcranial approach to the anterior skull base.

Keywords: Transillumination of frontal sinus; anterior skull base; frontal craniotomy; osteoplastic flap; subcranial approach.

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Figures

Figure 1
Figure 1
Raising of scalp flap with galea-pericranium and exposing frontal and nasal bone. Supratrochlear and supraorbital neurovascular bundles have been carefully dissected and included in the flap.
Figure 2
Figure 2
Transillumination of left frontal sinus through thin superomedial orbital wall by a fiber-optic light source and marking of frontal sinus boundary, staying 5 mm inside.
Figure 3
Figure 3
Complete marking of the frontal sinus boundaries for bifrontal craniotomy.
Figure 4
Figure 4
Bone flap being detached from septum after osteotomy with sagittal saw.
Figure 5
Figure 5
Bone flap.
Figure 6
Figure 6
Drilling of posterior wall of frontal sinus.
See this image and copyright information in PMC

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