Presentation
History of seizure disorder managed with antiepileptics who presented with two recent episodes of tonic-clonic seizures, noted to be different in character from prior seizures.
Patient Data
There is expansion of the right frontal sinus with attenuated material. There is thinning of the posterior wall of the right frontal sinus/inner table of the frontal calvarium. No evidence of dehiscence. There is bowing of the medial wall of the left frontal sinus. The right frontal recess is slightly expanded and opacified with CSF density as well. Normal aeration of the left frontal sinus and recess.There is mild opacification of the right anterior ethmoid air cells. The cribriform plates and remainder of the ethmoid tegmen are approximately symmetric. Medial orbital walls are intact.
Moderate retention cysts in the alveolar recess of the left maxillary sinus. Small retention cysts in the alveolar recess of the right maxillary sinus.
A T1 hypointense/T2 hyperintense peripherally enhancing extra-axial mass at the right anterior intracranial fossa. The mass fills and probably arises from the right frontal sinus resulting in its complete opacification. The posterior wall of the right frontal sinus appears thickened and bowed posteriorly, impinging upon the dural surface of the right frontal lobe and displacing it posteriorly. This posterior displacement of the right frontal lobe is likely chronic in nature as no appreciable edema involving the affected portion of the right frontal lobe is demonstrated.
The inferior margin of the mass appears to extend through the right frontal ethmoidal recess drainage pathway as the anterior right ethmoid air cells are also opacified with enhancing soft tissue demonstrating enhancement and similar signal characteristics to the above noted mass situated at the right frontal sinus.
The mass is situated upon the roof of the medial right orbit without erosion or displacement of the intraorbital soft tissues.
Case Discussion
This is a case of a mucocele within the right frontal sinus. The patient underwent endoscopic Draf III frontal sinusotomy and resection of the frontal sinus mass, right maxillary antrostomy, and total ethmoidectomy. Pathology of the resected mass did not identify a neoplasm. The changes oted within the specimen were most consistent with inflamed mucosa, with secondary reactive bone changes.
Aside from mild drainage, she did well during the postoperative course without headache, vision changes, significant rhinorrhea, or subsequent seizures at 1-, 4-, and 8-week follow up. Repeat MRI at 5-month post-op only revealed residual mucosal thickening in the right maxillary sinus, but no recurrence of the mucocele.
Co-author:
Luciano Venturino
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