Endoscopic management of bilateral frontal mucopyoceles: A Case Report and Literature review

•Surgery is the modality of choice to achieve complete evacuation of the mucocele and reestablishing the normal sinus outflow.•In determining the surgical approach to mucoceles, two main factors are considered: the patency of the ipsilateral frontal sinus outflow and the accessibility of the sinus via endoscope.•The endonasal endoscopic image guided approach is a safe, accurate, and reliable approach with no complications.•The concept behind the utility of image guidance in endoscopic marsupialization.•It is the approach of choice in managing large frontal mucopyocele with brain extension. To demonstrate the effectiveness of the endonasal endoscopic approach in managing a large bilateral frontal mucopyocele causing a mass effect on the brain. A 17 year old chronic sinusitis patient, presented with bilateral nasal obstruction and increasing left sided headache; was found to have a very large bilateral frontal mucopyoceles with extensive intracranial extradural brain involvement on CT scan and MRI of the sinuses and brain which was drained and evacuated completely using the endonasal endoscopic image guided approach with no complications. The endonasal endoscopic image guided approach is the approach of choice in managing large frontal mucopyocele with brain extension. It is a safe, accurate, reliable approach with no complications.