Head and Neck Pathology

, Volume 6, Issue 3, pp 384–388 | Cite as

Frontal Sinus Osteoma with Osteoblastoma-like Histology and Associated Intracranial Pneumatocele

  • Larisa M. LehmerEmail author
  • Phillip Kissel
  • Bruce D. Ragsdale
Case Report


Osteomas of the cranial sinuses are rare, benign bony tumors that can be complicated by the formation of an intracranial pneumatocele. If not treated promptly, a pneumatocele can lead to abscess formation, meningitis, or ventriculitis. In the present case, an intracerebral pneumatocele was formed when an 18 cm3 osteoma breached the posterior wall of the frontal sinus creating a one-way valve through which air could enter the intracranial cavity. The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere. A partly mineralized mass occupied the left superior nasal ethmoid sinus and left frontal sinus. Of interest pathologically in this case, the tumor had a substantial osteoblastoma-like component. Surgical repair involved frontal craniotomy to remove the osteoma and debride frontal sinus mucosa, plugging the frontal nasal ducts and sinus with fat and bone wax, and dural restoration using an underwater closed drainage system to vent intracranial air and stabilize the patient.


Frontal sinus osteoma Osteoblastoma-like areas Pneumatocele Headache 


  1. 1.
    Yiotakis I, Eleftheriadou A, Giotakis E, et al. Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty. World J Surg Oncol. 2008;6:110.PubMedCrossRefGoogle Scholar
  2. 2.
    Rappaport J, Attia E. Pneumocephalus in frontal sinus osteoma: a case report. J Otolaryngol. 1994;23:430–6.PubMedGoogle Scholar
  3. 3.
    Earwaker J. Paranasal sinus osteomas: a review of 46 cases. Skeletal Radiol. 1993;22(6):417–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Herring W. Chapter 21: recognizing abnormalities in bone density. In: Herring W, editor. Learning radiology: recognizing the basics. Philadelphia: Mosby Inc.; 2012. p. 218–29.Google Scholar
  5. 5.
    Gupta S, Venkatesh SK, Gupta N, et al. Post traumatic intracerebral pneumatocele presenting as CSF rhinorrhea: a case report. Ind J Radiol Imag. 2006;16:735–8.CrossRefGoogle Scholar
  6. 6.
    Cushing H. Experiences with orbito-ethmoidal osteoma having intracranial complications. Surg Gynecol Obstet. 1927;44:721–42.Google Scholar
  7. 7.
    Johnson D, Tan L. Intraparenchymal tension pneumatocele complicating frontal sinus osteoma: case report. Neurosurgery. 2002;50(4):878–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Erahn Y, Karabiyikolu M, Mutluer S. Air in intracerebral haematoma. Online J Neurosci [Turkish]. 1999;16:1–3.Google Scholar
  9. 9.
    Commins DJ, Tolley NS, Milford CA. Fibrous dysplasia and ossifying fibroma of the paranasal sinuses. J Laryngol Otol. 1998;112(10):964–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Eller R, Sillers M. Common fibro-osseous lesions of the paranasal sinuses. Otolaryngol Clin North Am. 2006;39(3):585–600.PubMedCrossRefGoogle Scholar
  11. 11.
    Tsai TL, Ho CY, Chen W, et al. Fibrous dysplasia of the ethmoid sinus. J Chin Med Assoc. 2003;66(2):131–3.PubMedGoogle Scholar
  12. 12.
    Marvel JB, Marsh MA, Catlin FI. Ossifying fibroma of the mid-face and paranasal sinuses: diagnostic and therapeutic considerations. Otolaryngol Head Neck Surg. 1991;104(6):803–8.PubMedGoogle Scholar
  13. 13.
    Margo CE, Ragsdale BD, Perman KI, et al. Psammomatoid (juvenile) ossifying fibroma of the orbit. Ophthalmology. 1985;92:l50–9.Google Scholar
  14. 14.
    Garstecka A, Mackiewicz-Nartowicz H, Szukalski J. Benign osteoblastoma of the frontal sinus. Otolaryngol Pol. 2004;58(3):649–52.PubMedGoogle Scholar
  15. 15.
    McHugh JB, Mukherji SK, Lucas DR. Sino-orbital osteoma: a clinicopathologic study of 45 surgically treated cases with emphasis on tumors with osteoblastoma-like features. Arch Pathol Lab Med. 2009;133(10):1587–93.PubMedGoogle Scholar
  16. 16.
    Bertoni F, Bacchini P, Donati D, et al. Osteoblastoma-like osteosarcoma. The Rizzoli Institute experience. Mod Pathol. 1993;6(6):707–16.PubMedGoogle Scholar
  17. 17.
    Mendelsohn DB, Hertzanu Y, Friedman R. Frontal osteoma with spontaneous subdural and intracerebral pneumatocele. J Laryngol Otol. 1984;98(5):543–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Markham JW. The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien). 1967;16(1):1–78.CrossRefGoogle Scholar
  19. 19.
    Sprague A, Poulgrain P. Tension pneumocephalus: a case report and literature review. J Clin Neurosci. 1999;6(5):418–24.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Larisa M. Lehmer
    • 1
    Email author
  • Phillip Kissel
    • 2
  • Bruce D. Ragsdale
    • 1
  1. 1.Central Coast PathologySan Luis ObispoUSA
  2. 2.Neurological and Spinal SurgerySan Luis ObispoUSA

Personalised recommendations