Image-guided frontal trephination: A minimally invasive approach for hard-to-reach disease

Abstract Objectives: Frontal sinus pathology that is located at the peripheral margins of the frontal sinus may be unreachable with standard endoscopic techniques. Patients with superiorly or laterally based lesions often require frontal osteoplastic flap with or without obliteration. Applying image guidance technology, a frontal trephination can be localized to the site of pathology and can provide excellent exposure for endoscopic surgical treatment. Endoscopic surgery through an image-guided frontal trephination can provide effective, minimally invasive treatment, sparing the morbidity of an osteo plastic flap. We present a series of 10 patients in whom this novel technique has been successfully applied. Methods: The clinical records and radiographic images of 10 patients undergoing image-guided frontal trephination were retrospectively reviewed. Results: The patient cohort had a mean age of 52 years, with a range of 16–79. Mean follow-up time was 11.9 months. The indications for image-guided trephination were: superiorly or laterally based mucoceles (4); fibrous dysplasia (2); type 4 frontal cell pathology (2); frontal recess stenosis with complicated frontal sinusitis (2). Four patients had previous external surgical approaches with secondary scarring in the frontoethmoid region. In 8 patients, image-guided trephination was combined with endoscopic transethmoid frontal sinusotomy, whereas 2 patients were successfully treated solely through a trephination approach. No patients required revision, and all patients remain symptom-free to date. Conclusions: Image-guided frontal trephination enables targeted localization of frontal sinus pathology for endoscopic surgical treatment. The image-guided frontal trephination procedure offers a minimally invasive, mucosal sparing technique that is an attractive alternative to osteoplastic flap.