Total recovery of visual acuity in a pediatric patient with compressive optic neuropathy secondary to sphenoid sinus mucocele / Recuperação total da acuidade visual na neuropatia óptica compressiva secundária à mucocele do seio esfenoidal em paciente pediátrico

ABSTRACT We present an unusual case of a 13-year-old male pediatric patient with a diagnosis of sphenoid sinus mucocele. The patient suffered a progressive loss of visual acuity over three months followed by a total recovery of his visual acuity after surgery. The patient presented at the emergency room complaining of progressive loss of visual acuity in his left eye which decreased to hand motion over the preceding months. Imaging studies revealed a cystic mass, suggestive of sphenoid sinus mucocele, which was causing compressive optic neuropathy and proptosis. The patient was scheduled for a sphenoidectomy and resection of the mass. Three days after surgery, the patient's visual acuity in the left eye was 20/20, indicating complete recovery from his symptoms. We suggest that the excellent outcome in this patient may be attributable to his age. His ongoing physical development might have been the decisive factor in the recovery of his visual acuity following compressive optic neuropathy secondary to sphenoid sinus mucocele. Further research is needed to verify this proposed explanation.

RESUMO Apresentamos um caso incomum de paciente pediátrico com diagnóstico de mucocele de seio esfenoidal, que apresentou perda progressiva da acuidade visual ao longo de três meses, resultando em recuperação total da acuidade visual após a cirurgia. Paciente do sexo masculino, 13 anos, procurou o pronto-socorro, queixando-se de perda progressiva da acuidade visual do olho esquerdo nos últimos três meses. Exames de imagem revelaram uma massa cística sugestiva de mucocele de seio esfenoidal, causando neuropatia óptica compressiva e proptose. O paciente foi agendado para esfenoidectomia e ressecção da massa. Três dias após a cirurgia, a acuidade visual do paciente no olho esquerdo era de 20/20, apresentando recuperação completa dos sintomas. Diante dos resultados de nosso paciente, sugerimos que a idade do paciente pode ser decisiva na recuperação da acuidade visual de uma neuropatia óptica compressiva secundária à mucocele de seio esfenoidal. Mais pesquisas são necessárias para verificação desses dados.

Application of Sphenoid Sinus Morphological Characteristics in Sex Estimation Based on Magnetic Resonance Imaging Images / Aplicación de las Características Morfológicas del Seno Esfenoidal en la Estimación del Sexo Basada en Imágenes de Resonancia Magnética

SUMMARY: Sex determination of unknown persons plays an important role in forensic science. As most bones used for sex determination are recovered in incomplete state, it is often necessary to use bones that are recovered intact e.g., the sphenoid sinus. This study aimed to evaluate the diagnostic value of sphenoid sinuses dimensions for sex determination using Magnetic Resonance Imaging (MRI) images in Chinese adults. MRI images of 79 sphenoid sinuses (from 44 men and 35 women) were retrospectively selected. The height, anterior-posterior diameter, area, and perimeter were measured in the midsagittal view of the sphenoid sinuses. All data were subjected to descriptive and discriminative functional analysis with unpaired t-test and canonical discriminant. Comparison between male and female groups showed significant statistical differences regarding the height, anterior-posterior diameter, area, and perimeter of sphenoid sinuses. The predictive accuracy rate of the sphenoid sinus to identify sex was 63.6 % in males and 62.9 % in females with an overall accuracy of 63.3 %. This study proposed the importance of sexual dimorphism of sphenoid sinus dimensions, especially if other methods are not available. It suggested using MRI in forensics science thus obviating the complete dependence on the usage of conventional computed tomography (CT) and facilitating the study of forensic anatomy at the level of soft tissue.

La determinación del sexo de personas desconocidas juega un papel importante en la ciencia forense. Como la mayoría de los huesos utilizados para la determinación del sexo se recuperan en un estado incompleto, a menudo es necesario utilizar huesos recuperados intactos, por ejemplo, el seno esfenoidal. Este estudio tuvo como objetivo evaluar el valor diagnóstico de las dimensiones de los senos esfenoidales para la determinación del sexo utilizando imágenes de resonancia magnética en individuos adultos chinos. Se seleccionaron retrospectivamente imágenes de resonancia magnética de 79 senos esfenoidales (de 44 hombres y 35 mujeres). La altura, el diámetro anteroposterior, el área y el perímetro de los senos esfenoidales, se midieron en vista mediana sagital. Todos los datos se sometieron a análisis funcional descriptivo y discriminativo con prueba t no pareada y discriminante canónico. La comparación entre los grupos de hombres y mujeres mostró diferencias estadísticas significativas en cuanto a la altura, el diámetro anteroposterior, el área y el perímetro de los senos esfenoidales. La tasa de precisión predictiva del seno esfenoidal para identificar el sexo fue del 63,6 % en hombres y del 62,9 % en mujeres, con una precisión general del 63,3 %. Este estudio propuso la importancia del dimorfismo sexual de las dimensiones del seno esfenoidal, especialmente si no se dispone de otros métodos. Se sugiere utilizar la resonancia magnética en la ciencia forense, obviando así la dependencia total del uso de la tomografía computarizada convencional y facilitando con esto el estudio de la anatomía forense a nivel de los tejidos blandos.

Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Patrones de neumatización del seno esfenoidal en la tomografía computarizada como parte de la evaluación preoperatoria para cirugía endoscópica transesfenoidal / Pneumatization pattern of the sphenoid sinus on computed tomography as part of preoperative evaluation for transsphenoidal endoscopic surgery

Introducción: la determinación del patrón de neumatización del seno esfenoidal (SE) y su relación con estructuras neurovasculares en el análisis tomográfico preoperatorio provee un mayor entendimiento de la anatomía para minimizar el riesgo intraoperatorio potencial sobre estructuras vitales. El objetivo de este estudio fue estimar la frecuencia de presentación de los diferentes tipos de neumatización del SE, protrusión/dehiscencia de la arteria carótida interna (ACI), septación intersinusal y neumatización "aberrante" en la evaluación de tomografía computarizada (TC) de senos paranasales en el Hospital Militar Central de Bogotá. Metodología: estudio observacional descriptivo de corte transversal que revisó 756 tomografías, de estas seleccionó aleatoriamente 422. Se estimó la frecuencia de presentación de cada tipo de neumatización del SE. Los hallazgos fueron analizados con estadística descriptiva. Resultados: el tipo de neumatización más frecuente utilizando la clasificación Güldner y colaboradores fue el tipo postsellar IVa, seguido del sellar y postsellar IVb. La protrusión y dehiscencia de la ACI estuvieron ambas más comúnmente presentes en los tipos de neumatización más extensa del SE, así como los patrones de neumatización "aberrante". El patrón de septación múltiple predominó en 86,3 % de los casos. Conclusiones: el análisis de la tomografía preoperatoria para cirugía endoscópica transesfenoidal es fundamental para reconocer el tipo de neumatización del SE y sus variantes, lo que permite minimizar el riesgo de lesionar estructuras vitales. La mayor extensión de la neumatización se relaciona con mayor frecuencia de variantes de riesgo de la ACI, estos tipos de neumatización más extensa predominaron en este estudio.

Background: The determination of the pneumatization pattern of the Sphenoid Sinus (SS) and its relationship with neurovascular structures in the preoperative tomogra-phic analysis provides a greater insight of the SS anatomy to minimize the potential intraoperative risk to vital structures. The objective of this study was to estimate the frequency of presentation of the different types of pneumatization of the SS, protrusion/dehiscence of the Internal Carotid Artery (ICA), intersinus septation and aberrant pneumatization in the evaluation of CT scan of paranasal sinuses in the Central Military Hospital from Bogota. Methods: A descriptive cross-sectional stu-dy. It reviewed 756 CT scans, randomly selecting 422 of these. The frequency of presentation of each type of pneumatization of the SS was estimated. The findings were analyzed with descriptive statistics. Results: The most frequent type of pneu-matization using the Güldner et al. classification was the Postsellar IVa, followed by the Sellar and Postsellar IVb. The protrusion of the ICA and its dehiscence were both more commonly present in the more extensive types of pneumatization of the SS, as well as "aberrant" pneumatization patterns. The multiple septation pattern predominated in 86.3% of the cases. Conclusion: The analysis of preoperative to-mography for transsphenoidal endoscopic surgery is essential to recognize the type of pneumatization of the SS and its variants, which allows minimizing the risk of injuring vital structures. The greater extent of pneumatization is related to a greater frequency of risk variants of ICA; these types of more extensive pneumatization predominated in this study.

Implications of anatomical variation of the sphenoid sinus for orthognathic surgery: a case report in cone beam computed tomography / Implicações da variação anatômica do seio esfenoidal para cirurgia ortognática: um relato de caso em tomografia computadorizada de feixe cônico

ABSTRACT The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.

RESUMO O Seio Esfenoidal é considerado o seio paranasal com maior variação quanto ao grau de pneumatização. Assim, este trabalho objetivou relatar o primeiro caso sobre a interferência dessa variação anatômica para a cirurgia ortognática. Mulher,18 anos, com fissura de palato isolada reparada, foi submetida à cirurgia ortognática para correção da discrepância esquelética maxilomandibular. O exame de tomografia computadorizada de feixe cônico (TCFC), realizado para planejamento pré-operatório, mostrou grande extensão para as estruturas adjacentes, e com proximidade da parede posterior do seio maxilar e fissura pterigomaxilar bilateralmente. A imagem de TCFC pós-operatória evidenciou o comprometimento do assoalho do seio devido aos fatores relacionados ao transoperatório. Este caso, juntamente com a revisão da literatura, destacou a importância de identificar a variação do seio esfenoidal nos exames de TCFC prévios à cirurgia ortognática, a fim de evitar complicações graves para o paciente, tais como sinusite, hemorragias, formação de mucoceles ou, até mesmo, envolvimento intracraniano.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

Radioanatomical Features of the Sphenoid Sinus in the Ivorian Population

Background and purpose: The sphenoid sinus is characterized by the frequency of anatomical variants that cause operative difficulties and complications during the transphenoidal approach. These variants involve the geographic factor and the type of skin phenotype. Most of the studies have been carried out on European, North African and Asian populations. Some studies have been found in sub-Saharan Africa but not in Côte d’Ivoire. The aim was to determine, from CT data, the anatomical characteristics of the sphenoid sinus in the Ivorian population. Methods: Cranioencephalic computed tomography images of 100 patients (80 men and 20 women aged 16 to 71) were used for the study. These were patients who presented with head trauma without injury to the base of the skull. Were studied the anatomical characteristics of the sphenoid sinus. Results: The type of pneumatization was sellar in 58% sinuses, pre sellar in 41% and conchal in 1% of cases. The presellar type predominated in women (60%) and the sellar type in men (65.5%). Extensions were present in 66.34% of cases, more frequent in men (70%), in the sellar type (79.31%), and in the anterior clinoid process (46.20%). The procidence of vasculo-nervous structures was more frequent in men (52.62%) and in the sellar type (62.07%), the procidence of the internal carotid artery was bilateral in 30.69% of sinuses, that of the optic nerve was mainly unilateral left (07.92%) more frequent in women ( 10%) and in the sellaire type (09.43%). Dehiscence was present in 15% of cases. Dominance was straight in 63.64% of the sinuses. The Onodi cell was present in 65% of sinuses. The ostium was bilateral in (45%) of the sinuses. Conclusion: The Ivorian sphenoid sinus is highly pneumatized, facilitating access to the surgeon; the sellar type is the most frequent. On the other hand, the frequency of procidence and dehiscence of vasculo-nervous elements increases the risk of surgical complications. Differences between genders and between types of pneumatization should be considered in sphenoid sinus procedures.

Neumatización detenida del seno esfenoidal: una condición benigna que simula lesiones patológicas / Arrested pneumatization of the sphenoid sinus: a benign condition that simulates pathological lesions

Resumen La neumatización detenida de los senos paranasales es una condición benigna poco conocida, que consiste en una variación de la neumatización normal, permaneciendo médula ósea grasa dentro de la cavidad, siendo más frecuente en el seno esfenoidal. Es generalmente asintomática y su diagnóstico suele ser incidental en el contexto de la realización de imágenes por otras causas, existiendo criterios imagenológicos definidos para esta condición. Su manejo es expectante y es esencial su distinción de otros diagnósticos diferenciales, con objeto de evitar procedimientos y tratamientos invasivos que solo aporten morbilidad. Presentamos dos casos de pacientes, de 15 y 16 años que, en estudio imagenológico por otra causa, se observan lesiones esfenoidales heterogéneas con focos de baja señal sugerentes de calcificaciones, con características compatibles con neumatización detenida del seno esfenoidal.

Abstract Arrested pneumatization of the paranasal sinuses is an under-recognized benign condition, which consists of a variation of the normal pneumatization, with fatty bone marrow remaining within the cavity, more frequent in the sphenoid sinus. It is generally asymptomatic, and its diagnosis is usually incidental in the context of imaging for other causes, with defined imaging criteria for this condition. Its management is expectant and its distinction from other differential diagnoses is essential, in order to avoid invasive procedures and treatments that only contribute morbidity. We present two cases of 15- and 16-year-old patients who, on imaging for another reason, show heterogeneous sphenoid lesions with low-signal foci suggestive of calcifications, with characteristics compatible with arrested pneumatization of the sphenoid sinus.

A review of common anatomical variants of paranasal sinuses and nasal cavity and its frequency of occurrence as evidenced on multi-detector computed tomography

This study was carried out to know the frequency of occurrence of common anatomic variants in computed tomography of paranasal sinuses and nasal cavity. Non contrast Computed tomography (CT) of paranasal sinuses of 100 patients referred to Department Of Radiology, Saveetha Medical College were retrospectively studied. The Multi-detector computed tomography (MDCT) scans were evaluated for various anatomical variants of paranasal sinuses and nasal cavity. The frequency of occurrence was calculated in percentage.We found out that deviated nasal septum (DNS) was the most common variant in this study, seen in 86% of cases, followed by Agger nasi cells which was seen in 56% and the third most common was supra-orbital ethmoidal cells seen in 42% of the study population. All the cases included in the study, had minimum of one variant. Most of the study population showed multiple anatomical variations of paranasal sinus and nasal cavity. In conclusion, multidetector Computed tomography plays an important role is the assessment of various anatomical variants of the paranasal sinuses and nasal cavity. Pre-operative MDCT of Paranasal sinuses, gives the surgeons most if not all of the anatomical information they need to tailor surgeries. Considering the relatively high frequency of occurrence of these variants, it is essential for the radiologists to have a precise knowledge of imaging features of normal anatomy and anatomical variants of Paranasal sinuses.

Detection of Neuroendocrine Tumour of Sphenoid Sinus on the Gallium-68 DOTATATE PET/CT: A Rare Entity

@#Neuroendocrine tumours (NETs) are a category of neoplasm that is characterised by its phenotypic and heterogeneity. The occurrence of this type of neoplasm in the nasal cavity and paranasal sinuses is extremely rare accounting for only 0.2-0.8% of all cancers. NET tends to expresses somatostatin receptors (SSTR) and owning to this unique characteristic, molecular imaging has been able to detect these tumours using radiolabelled somatostatin analogue agent. Gallium-68 (Ga-68) DOTATATE PET/CT is an example of SSTR imaging and has been shown to be of importance in the assessment and staging of NET. We present a case of a rare sphenoid sinus NET in a 45-year-old gentleman whom initially presented with persistent left eye pain which led to visual loss. We described the utilization of Ga-68 DOTATATE PET/CT in the diagnosis and staging of this patient which in turn dictated treatment approach.

Role of High-Resolution Computed Tomography in the Evaluation of Anatomical Variations of Sphenoid Sinus and Its Clinical Importance in FESS.

Sphenoid sinus of all sinuses is generally the most inaccessible sinus to the surgeons. The trans-sphenoid route is considered to be the standard approach for surgery of pituitary adenomas. Knowing the details of the anatomy of sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of the approach. We wanted to evaluate the incidence of the different anatomical variations of sphenoid sinus as detected by HRCT scan and their impact on related neurovascular structures for the safe removal of inter sphenoid and pituitary lesions.METHODSThis prospective study was conducted in Sree Gokulam Medical College & Research Foundation, Trivandrum. Study population included 150 cases who were referred for HRCT of the paranasal sinuses to the Department of Radiodiagnosis, over a period of 12 months (from November 2018 to October 2019). After obtaining a written informed consent and history, all the patients underwent HRCT axial section of PNS. Once the axial sections were obtained through the paranasal sinuses, these images were reconstructed into coronal sections by multiplanar reconstruction (MPR) technique without exposing the patient.RESULTSOnodi cells were found predominantly in female patients with male:female ratio 2:7. Optic nerve protrusion and dehiscence had male predominance. Rest of the variations had no significant gender difference and few variations were seen equally distributed among both males and females. The most common variation observed in our study was pterygoid process pneumatization. Of the total 150 patients, pterygoid process pneumatization was identified in 76 patients including bilateral in 54 patients. Next common variation observed was vidian nerve protrusion, identified in 62 patients along with dehiscence of wall in 38 patients. Maxillary nerve protrusion was present in 42 patients and its dehiscence of wall in 10 patients. Optic nerve protrusion was identified in 41 patients and dehiscence of wall was noted in only 6 patients.CONCLUSIONSSphenoid sinuses are the most inaccessible paranasal sinuses and are surrounded by significant anatomical structures such as the orbit and its contents, cavernous sinus, internal carotid artery (ICA) and the anterior cranial fossa. HRCT of sphenoid sinus for the demonstration of the anatomical variations and its relation to the vital adjacent crucial anatomical structures helps in reducing the complications during trans-sphenoidal surgeries and functional endoscopic sinus surgery. Our study of HRCT findings delineates most of the anatomical variations in sphenoid sinus and thus helps the surgeons in appropriate surgical planning and helps them to reduce the intraoperative complications.

Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

Binasal hemianopia caused by pneumosinus dilatans of the sphenoid sinuses

Bitemporal hemianopia is a significant pathological hallmark of a pituitary lesion; however, binasal hemianopia is rarely reported, except for its known association with other ocular diseases rather than with brain lesions. We report a 24-year-old male with binasal hemianopia caused by pneumosinus dilatans of the sphenoid sinuses.

Gender Distribution and Clinical Significance of Pneumatization in Sphenoid Sinus

Introduction: Pneumatization of the sphenoid sinus is highlyvariable and it depends on the position of the sinus in relationto the sella turcica. The pattern of pneumatization of sphenoidsinus significantly affects safe access to the sella. Pneumatizedsphenoid sinus may distort the anatomical configuration so ifunaware, accidental injury can occur during invasive surgicaltechnique.Material and methods: This cross sectional observationalwas conducted by Postgraduate Department of Anatomyin collaboration with Department of Radiodiagnosis andImaging, Government Medical College, Srinagar. Thisstudy was done on CT scan of 200 cases (120 males and 80females). Since the aim of our study was to evaluate normalvariation in pneumatization of sphenoid sinus, cases foundto harbor pathology or disease enough to distort the regionalanatomy were excluded from the study. Extent of sphenoidpneumatization in relation to pituitary fossa was studied insagittal plane and categorized as sellar, presellar and conchal.Results were categorized for males and females separately.RESULTS: In our study of 200 cases, sellar type of sphenoidsinus pneumatization was majority accounting 180 (90%)while 18 (9%) were presellar and 2 (1%) were of chonchaltype. Both cases of chonchal type were males.Conclusion: The study was performed to demonstratesurgically dangerous variations of sphenoid sinuspneumatization for the safe removal of the intrasphenoid andpituitary lesions, with the goal of preventing complicationsand achieving the best possible results.

Anatomical variations of intra-sphenoid sinus septations in a sample of Kashmiri population: a non-contrast computed tomography study

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

Neumatización gigante del seno esfenoidal: Reporte de cuatro casos y revisión de la literatura / Giant pneumatization of sphenoid sinus: Report of four cases and review of literature

El hueso esfenoidal ocupa la mayor parte de la zona anterior de la fosa craneal media, está compuesto por un cuerpo, dos pares de alas (mayores y menores) las que se proyectan lateralmente desde el cuerpo, y dos procesos pterigoideos proyectados inferior y lateralmente de las coanas. Este hueso representa el límite entre la fosa craneal anterior y media. Usualmente, el seno esfenoidal se encuentra ubicado en su cuerpo, el cual presenta una gran variación en su neumatización, variando desde ausente hasta extenso. Puede extenderse a distintas partes del hueso esfenoidal e inclusive a estructuras óseas cercanas. Su localización profunda hace difícil el diagnóstico mediante radiografías, especialmente cuando se utilizan técnicas convencionales. Se presentan cuatro casos de neumatización gigante del seno esfenoidal observados como hallazgo imagenológico. (AU)

Sphenoid bone occupies most of the anterior part of the middle part of the skull base, it is compound by a body, two pair of wings (greater and lesser) which are laterally projected from the body and two pterygoid process projected inferiorly and laterally from choana. This bone represents the limit between the anterior and middle cranial fossa. Usually, the sphenoid sinus is located in the sphenoid body, and has a large variation in its pneumatization, ranging from absent to extensive. It is able to extent to different parts of the sphenoid bone or even to surrounding ones. The deep location makes difficult the radiographic diagnosis, especially when conventional radiographic techniques are used. Four cases of a giant pneumatization of the sphenoid sinus are presented observed as a radiological finding. (AU)

Sphenochoanal Polyp Right With Left Septal Spur: Rare Entity

Choanal polyps can be classified as antrochoanal, sphenochoanal or ethmochoanal polyps depending upon the site of origin, in comparison to common nasal polyps and antrochoanal polyps, reports of sphenochoanal polyps are relatively rare. Authors present a case of a 18 year old boy presenting to the clinic with unilateral nasal obstruction and nasal tone in voice, which was a diagnostic dilemma for the radiology department as it was misdiagnosed unable to be differentiated by CT scan. MRI scan of the patient confirmed the diagnosis of a sphenochoanal polyp. We aspire to widen the horizon of the knowledge by discussing the case and enabling timely diagnosis and treatment.

Non-traumatic cerebrospinal fluid leak from a sphenoid sinus midline roof defect previously managed as allergic rhinitis

@#<p><strong>OBJECTIVE: </strong>To present a case of a non-traumatic cerebrospinal fluid (CSF) rhinorrhea from a midline sphenoid sinus roof that presented as a persistent postnasal drip and was previously managed as allergic rhinitis for 43 years.</p><p><strong>METHODS:</strong></p><p>            <strong>Design:</strong>           Case Report</p><p>            <strong>Setting:</strong>           Tertiary Private University Hospital</p><p>            <strong>Participant:</strong>     One</p><p><strong>RESULTS:</strong> A 58-year-old obese and hypertensive man presented with persistent post nasal drip and intermittent clear watery rhinorrhea. He had been managed as a case of allergic rhinitis for 43 years and was maintained on nasal steroid sprays without relief. Nasal endoscopy revealed pulsating clear watery discharge from the sphenoid ostium. On trans-sphenoidal surgery, a midline sphenoid sinus roof defect was sealed using a Hadad-Bassagasteguy flap.</p><p><strong>CONCLUSION:</strong> CSF rhinorrhea is uncommon and may mimic more common diseases such as allergic rhinitis. Because misdiagnosis can then lead to life threatening complications, physicians should be vigilant when seeing patients with clear watery rhinorrhea to be able to arrive at a proper diagnosis and provide prompt treatment.</p><p> </p><p><strong> </strong></p>

The determination of sphenoid sinus dimensions in Turkish healthy adult subjects: an MRI study / Determinación de las dimensiones del seno esfenoidal en sujetos adultos sanos turcos: un estudio de resonancia magnética

SUMMARY: The aim of this study was to identify sphenoid sinus dimensions; and distance between columella nasal and sphenoid sinus; and columella nasal and hypophysis in healthy adult subjects using magnetic resonance imaging (MRI) and to evaluate differences between genders and age groups. The MRI results of 300 healthy subjects (192 females; 108 males) aged 18-68 years were studied. The midsagittal and axial images were used for shape of the sphenoid sinus, and the distance measurements of its related adjacent structures on MRI. The mean values of the distance between columella nasal; and columella nasal and hypophysis; and sinus sphenoidalis width were 65.73±5.22 mm, 87.05±4.79 mm and 37.67±8.40 mm in females respectively, whereas the same values were 71.79±5.06 mm, 94.52±6.07 mm and 41.95±9.32 mm in males, respectively. The means of all measurements were lower in healthy female subjects than in healthy males.Additionally, the classification of sphenoid sinus types were determined to be postsellar type (131), sellar type (46), presellar type (14) and conchal type (1) in females, respectively. The same measurement were determined as postsellar type (82), sellar type (23) and presellar type (3) in males, respectively. Differences between sexes and age related changes were observed in the variations of the size, location and shape of sphenoid sinus were observed The observations presented in this report have defined anatomic parameters that need to be taken into consideration for reference data to determine gender discrepancies, age related changes and helpful for radiologists and clinicians to plan safe surgical approach and avoid surgical risks.

RESUMEN: El objetivo de este estudio fue identificar las dimensiones del seno esfenoidal y la distancia entre la columela nasal y el seno esfenoidal y, la glándula nasal y la hipófisis en sujetos adultos sanos con imágenes de resonancia magnética (RM), para evaluar las diferencias entre los sexos y los grupos de edad. Se estudiaron los resultados de RM de 300 sujetos sanos (192 mujeres, 108 hombres) de 18 a 68 años. Se usaron imágenes sagitales y axiales para la forma del seno esfenoidal y las mediciones de distancia de sus estructuras adyacentes relacionadas en la RM. Los valores medios de la distancia entre columela nasal; y columela nasal e hipófisis; y la anchura del seno esfenoidal fue de 65,73 ± 5,22 mm, 87,05 ± 4,79 mm y 37,67 ± 8,40 mm en mujeres, respectivamente, mientras que los mismos valores fueron de 71,79 ± 5,06 mm, 94, 52 ± 6,07 mm y 41,95 ± 9,32 mm en varones, respectivamente. Las medias de todas las mediciones fueron menores en mujeres sanas que en hombres sanos. Adicionalmente, se determinó que la clasificación del seno esfenoidal era de tipo postsellar (131), tipo selar (46), tipo presellar (14) y tipo conchal (1), en las mujeres, respectivamente. Las mismas medidas se determinaron como tipo postsellar (82), tipo sellar (23) y tipo presellar (3) en varones, respectivamente. Se observaron diferencias entre sexos y los cambios relacionados con la edad en las variaciones de tamaño, ubicación y forma del seno esfenoidal. Las observaciones presentadas en este informe establecen parámetros anatómicos que se deben considerar como referencia para determinar las diferencias de sexo, y edad. La información de estas diferencias será útil para los radiólogos y los médicos en la planificación de un abordaje quirúrgico seguro y para evitar riesgos quirúrgicos.

Two Cases of Bilateral Paranasal Sinus Fungus Balls with Sphenoid Sinus Involvement / 대한이비인후과학회지

A fungus ball is the most common manifestation of fungal sinusitis. Bilateral involvement of fungus balls is rare, and bilateral sphenoid involvement is even more uncommon. The authors report two cases of bilateral fungus balls with sphenoid sinus involvement successfully treated with endoscopic sinus surgery. Both patients complained of nonspecific headache; diagnoses were made with CT and histopathological examinations, and surgical removal was achieved via transostial approach. Bilateral fungus balls involving the sphenoid sinus are rare but do occur; their removal is possible through endoscopic sinus surgery with a high cure rate. We thus recommend using CT scanning to identify typical findings of a sphenoid fungus ball even in bilateral paranasal sinusitis and perform aggressive surgical treatment.