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. 2013 Jul;17(3):246-50.
doi: 10.7162/S1809-97772013000300003.

Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

Jan Alessandro Socher  1 , Pedro Geisel Santos  2 , Vinicius Cidral Correa  3 , Leandro Caetano de Barros E Silva  3
Affiliations

Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

Jan Alessandro Socher et al. Int Arch Otorhinolaryngol. 2013 Jul.

Abstract

Introduction: The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses.

Aim: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques.

Method: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure.

Discussion: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months.

Conclusion: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective.

Keywords: Headache; Natural Orifice Endoscopic Surgery; Video-Assisted Surgery.

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Figures

Figure 1.
Figure 1.
Preoperative coronal section CT scan showing crista galli pneumatization with mucosal thickening.
Figure 2.
Figure 2.
Video-endoscopic visualization of the left nasal cavity showing the septal incision site and opening of the bone wall of the pneumatized crista galli. SEPTO = nasal septum; CM = middle turbinate; CI = inferior turbinate.
Figure 3.
Figure 3.
Coronal CT section showing mucosal thickening and obliteration of the pneumatized crista galli.
Figure 4.
Figure 4.
Intraoperative endoscopic visualization of the right nasal cavity showing septal incision and detachment. SEPTO = nasal septum; CM = middle turbinate.
Figure 5.
Figure 5.
Intraoperative endoscopic visualization of the right nasal cavity demonstrating septal resection to allow approach to the bone wall of the pneumatized crista galli. SEPTO = nasal septum; CM = middle turbinate.
Figure 6.
Figure 6.
Intraoperative endoscopic visualization of the right nasal cavity showing transseptal opening of the bone wall of the pneumatized crista galli. SEPTO = nasal septum; CM = middle turbinate.
Figure 7.
Figure 7.
Intraoperative endoscopic visualization of the right nasal cavity demonstrating the detail of opening of the pneumatized crista galli, the lining of which shows mucosal thickening and edema.
Figure 8.
Figure 8.
Coronal CT section showing mucosal thickening and fluid within the pneumatized crista galli.
See this image and copyright information in PMC

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