Trombosis del seno cavernoso derecho secundaria a rinosinusitis esfenoidal: reporte de caso / Right cavernous sinus thrombosis secondary to sphenoidal rhinosinusitis: case report

RESUMEN La rinosinusitis bacteriana aguda es la infección de la mucosa nasal y de senos paranasales, que se manifiesta con congestión nasal, rinorrea purulenta y fiebre, de curso generalmente autolimitado. La trombosis del seno cavernoso (TSC) es una complicación poco frecuente, que se asocia a compromiso del seno esfenoidal y etmoidal, manifestándose clínicamente con cefalea, fiebre, alteración de pares craneanos y síntomas oculares. Ante su sospecha el estudio imagenológico es fundamental. En estos exámenes se debe buscar un defecto de llene en el seno cavernoso comprometido. El tratamiento debe iniciarse de forma precoz y contempla: antibioticoterapia, drenaje quirúrgico del seno afectado y anticoagulación. Se presenta a un paciente pediátrico masculino con TSC derecha posterior a una rinosinusitis esfenoidal no tratada, que respondió favorablemente al tratamiento. Se describe la clínica y manejo de esta patología, que presenta alta morbimortalidad, y que puede disminuirse considerablemente con un tratamiento precoz y agresivo.

ABSTRACT Acute bacterial rhinosinusitis is the infection of the nasal and paranasal mucous membrane, with symptoms such as nasal congestion, purulent rhinorrhea and fever, usually self-limiting. Cavernous sinus thrombosis (CST) is a rare complication, which is associated with sphenoid and ethmoid sinus involvement, clinically manifest with headache, fever, cranial nerve involvement and ocular symptoms. When suspected, imaging studies will confirm the clinical impression. They will show abnormal flow parameters in the compromised cavernous sinus. The treatment has to start as soon as possible and consists in broad spectrum intravenous antibiotics, surgical drainage of the site of the infection and anticoagulation. We present a patient with a right CST secondary to a non-treated sphenoidal sinusitis, that responded favorably to treatment. The clinical and management of this pathology is described, which presents a high morbidity and mortality that can be reduced considerably with an early and aggressive treatment.

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to 5.6×3.4 cm with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

A Case of Septal Abscess and Sphenoid Sinusitis after Dental Implant / 대한이비인후과학회지

A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.

Bola fúngica de cavidades paranasales: serie de casos / Fungus ball of the paranasal sinuses: case series

RESUMEN Introducción La bola fúngica (BF) es una sinusitis fúngica no invasiva, con acumulación extramucosa de conglomerados densos de hifas de hongos en cavidades paranasales (CPN), afectando generalmente a mujeres inmunocompetentes. Objetivo Describir la presentación cínica, diagnóstico y tratamiento de una serie de pacientes con diagnóstico de BF de CPN. Material y método Estudio descriptivo retrospectivo de pacientes con diagnóstico histopatológico de BF sometidos a cirugía endoscópica nasal (CEN) en nuestra institución entre 2010 y 2016. Resultados Se incluyeron 20 pacientes (15 mujeres, 5 hombres), con edad promedio al diagnóstico de 64 años (35-86 años), la mayoría inmunocompetente (85%). El síntoma más frecuente fue dolor facial (8/20). Todos los pacientes fueron estudiados con tomografia computarizada (TC) de CPN, presentando calcificaciones en 70%. La ubicación más frecuente fue el seno maxilar (12/20) y luego esfenoidal (6/20). Se realizó CEN en todos los pacientes, combinándolo con Caldwell Luc en 3 de ellos. Los cultivos intraoperatorios resultaron negativos en el 75% de los pacientes. Conclusión La BF tiene presentación cínica inespecifica. Se sospecha en base a hallazgos imagenológicos en la TC de CPN y se confirma histopatológicamente, dado el bajo rendimiento de los cultivos. La CEN es la herramienta diagnóstico-terapéutica de elección, con baja tasa de recidiva local.

ABSTRACT Introduction A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of extramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.

Abducens Nerve Palsy and Optic Perineuritis Caused by Fungal Sphenoidal Sinusitis

PURPOSE: To report a case of abducens nerve palsy and optic perineuritis caused by fungal sphenoidal sinusitis. CASE SUMMARY: A 48-year-old male visited emergency department for retrobulbar pain, decreased vision, and horizontal diplopia for 3 days. He reported that previous medical history was non-specific, however, blood glucose level was 328 mg/dL (70–110). He had experienced severe headache for 7 days. The best corrected visual acuity was 20/20 at right eye and 20/25 at left eye. The pupil of left eye did not have relative afferent pupillary defect. Left mild proptosis was noted. The extraocular examination showed 30 prism diopters left esotropia at primary gaze and −4 abduction limitation of left eye. The left eye showed mild optic disc swelling and inferior field defect by field test. Brain magnetic resonance imaging showed enhancement of sphenoidal sinus, ethmoidal sinus, and around optic nerve at left eye. Three days after antibiotics treatment, the vision of left eye deteriorated to 20/40 and periorbital pain developed. The drainage and biopsy of sphenoidal sinus were performed. The histopathologic examination showed hyphae consistent with aspergillosis. The ocular symptoms were improved with anti-fungal treatment. Follow-up magnetic resonance imaging performed 1 month after treatment showed improvement of lesion at left orbit. Five months after surgery, the visual acuity of left eye was improved to 20/25. The patient showed orthotropia at primary gaze without limitation. CONCLUSIONS: The abducens nerve palsy and optic perineuritis can be caused by fungal sphenoidal sinusitis. The early diagnosis and appropriate treatment can lead to favorable outcome.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning / Papel das células de Onodi na esfenoidite: resultados da tomografia computadorizada com reconstrução multiplanar

Abstract Introduction Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. Objective To evaluate the effect of Onodi cells on the frequency of sphenoiditis. Methods A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. Results Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n = 73) were ipsilaterally (n = 21) or bilaterally (n = 52) Onodi-positive, whereas 39.7% (n = 48) were Onodi-negative (n = 35) or only contralaterally Onodi-positive (n = 13). Of the control group, 48.3% (n = 240) were Onodi-positive and 51.7% (n = 257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p < 0.05). Conclusion The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Resumo Introdução As células de Onodi são as células etmoidais mais posteriores, que se prolongam superolateralmente ao seio esfenoidal. Essas células também se encontram em íntima relação com o seio esfenoidal, o nervo óptico e a artéria carótida. Para análise de variações anatômicas antes da implantação de qualquer modalidade terapêutica relacionada ao seio esfenoidal, a avaliação radiológica é obrigatória, Objetivo Nosso objetivo foi avaliar o papel das células de Onodi na frequência de esfenoidite. Método Em nosso estudo, foi feita uma análise retrospectiva em 618 pacientes adultos que se submeteram à tomografia computadorizada de alta resolução entre janeiro de 2013 e janeiro de 2015. Avaliamos a prevalência de células de Onodi e de esfenoidite. Investigamos se a presença de células de Onodi leva a um aumento na prevalência de esfenoidite. Resultados A positividade para células de Onodi foi observada em 326 de 618 pacientes e sua prevalência foi de 52,7%. No grupo de estudo, 60,3% (n = 73) eram CO-positivas: ipsilateral (n = 21) ou bilateralmente (n = 52); e 39,7% (n = 48) eram CO-negativas (n = 35) ou apenas contralateralmente CO-positivas (n = 13). No grupo de controle, 48,3% (n = 240) eram CO-positivas; e 51,7% (n = 257) eram CO-negativas. Observamos que a coexistência de CO ipsilateralmente aumentava em 1,5 vez a associação com esfenoidite e esse achado foi estatisticamente significante (p < 0,05). Conclusão A prevalência de esfenoidite parece ser maior em pacientes com células de Onodi, mas não é possível afirmar que elas são isoladamente o fator causador dessa doença. Novos estudos precisam ser feitos para uma investigação dos fatores contributivos relacionados à esfenoidite.

Sphenoid Sinusitis with Haemophilus influenzae Septicemia / 대한내과학회지

Haemophilus influenzae grows both aerobically and anaerobically and is an exclusively human pathogen. We present a case of septicemia originating from unilateral sphenoid sinusitis caused by non-typeable H. influenzae. No reports of sinusitis presenting as septicemia in a healthy young immunocompetent adult in South Korea have previously been published.

Acute Rhinosinusitis in Prominently Pneumatized Sphenoid Sinus Presenting with Unilateral Abducens Nerve Palsy / 대한이비인후과학회지

Acute rhinosinusitis is a rare cause of abducens nerve palsy. Most reported cases with VIth cranial nerve palsy associated sphenoid sinusitis are fungal sphenoid sinusitis, mucocele, or severe bacterial sinusitis. In this report, we present a patient with acute mild sphenoid sinusitis presented as abducens nerve palsy associated with prominent sphenoid pneumatization to the Dorello's canal.

Clinical analysis of sphenoid sinusitis after transsphenoidal sellar surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the possible influence factors of sphenoid sinusitis after endoscopic transsphenoidal sellar surgery.</p><p><b>METHODS</b>A retrospective analysis of 177 patients who underwent transsphenoidal sellar surgery, from January 2009 to January 2014 in Tianjin Huanhu Hospital was performed. All patients were followed up with nasal endoscope. The risk factors of sphenoid sinusitis after surgery were analyzed statistically, such as sex, age, categories of disease, surgical produres, tumor size, using artificial or self material repair, with or without EC glue intraoperatively, etc. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>After surgery, there were 34 (19.2%) patients developed postoperative sinusitis. EC glue was the sole risk factor for postoperative sinusitis (34.57% vs 6.25%, χ(2)=22.701, P<0.01), but the sex, age, categories of disease, surgical produres, tumor size and patching material had no significant difference (all P>0.05).</p><p><b>CONCLUSIONS</b>In patients with endoscopic transsphenoidal sellar surgery, regular postoperative nasal endoscopic follow-up found that the use of EC glue was the risk factor for the development of postoperative sphenoid sinusitis.</p>

New daily persistent headache with isolated sphenoiditis in children / 소아과

Isolated sphenoid sinusitis is a rare disease in children, and its symptoms are often nonspecific and confusing. Rarely, severe headache can be the first or only symptom of isolated sphenoid sinusitis. New daily persistent headache (NDPH) is a form of chronic daily headache that may have features of both migraines and tension-type headaches. NDPH is difficult to diagnose and requires a multifaceted approach. Here, we report on a 10-year-old boy and an 11-year-old girl who both presented with typical NDPH symptoms. These patients had no nasal symptoms or signs of infection. Neither nonsteroidal anti-inflammatory drugs nor topiramate had any effect on the headaches. Their neurological and ophthalmological examinations were normal. The results of routine blood work, including thyroid function tests, inflammatory markers, complete blood count, tests for viral infection, and a metabolic panel, were normal. A brain magnetic resonance imaging scan showed isolated sphenoid sinusitis. Both patients' symptoms resolved completely after approximately 1 month of oral antibiotics for sinusitis.

Diagnosis and treatment of cavernous sinus syndrome caused by fungal infection to sphenoid sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus.</p><p><b>METHODS</b>The clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time.</p><p><b>RESULTS</b>After treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications.</p><p><b>CONCLUSIONS</b>Cavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.</p>

A Case of Pituitary Metastasis of Lung Cancer Presenting as Cavernous Sinus Syndrome / 대한이비인후과학회지

The cavernous sinus contains significant structures such as the internal carotid artery and cranial nerves III to VI. Cavernous sinus lesions may cause ophthalmoplegia, proptosis, and diplopia. We report a 56-year-old woman who presented with throbbing headache and associated right-sided ocular pain. While awaiting imaging studies, she suddenly developed opthalmoplegia and ptosis of the right eye. She had ipsilateral palsy of the third and fourth cranial nerves, while the sixth nerve remained intact. Magnetic resonance imaging revealed a pituitary gland mass extending into the right cavernous sinus with associated sphenoid sinusitis. The patient underwent endoscopic sinus surgery and subsequent pituitary tumor removal by transsphenoidal approach. During preoperative evaluation, a mass was found protruding in her left bronchus. The pituitary tumor pathologic examination revealed metastatic adenocarcinoma of the lung. In this patient, the initial symptoms of lung cancer were headache and cavernous sinus syndrome, which had metastasized to the pituitary gland.

Bilateral solitary fungus balls sphenoid sinus / 临床耳鼻咽喉头颈外科杂志

Diagnosis of sphenoid sinus disease is very difficult because the location of sinus is deep and hidden within the skull and the symptoms of sphenoiditis are nonspecific. However, thanks to new technologies in imaging (CT and MRI) and nasal endoscopy, the literature on sphenoid sinus fungus ball have been published more. But all of the SSFB which have been reported are isolated or unilateral. We reported one rare case of bilateral sphenoid sinus fungus balls. This patient was treated in our department. Headache was the only symptom in this case. The patient was treated by sphenoidotomy via endoscopic approach and removal both of the lesions. No recurrence was found after 6-months follow-up.

Orbital Apex Syndrome Related to Isolated Sphenoid Fungal Sinusitis

Orbital apex syndrome (OAS) has been described as malfunction of cranial nerve II in the optic canal and cranial nerves III, IV, V1, and VI in the superior orbital fissure due to vascular compromise, compression, or infiltration. Symptoms include ophthalmoplegia, ptosis, decreased corneal sensation, and vision loss. There are many potential causes of OAS including inflammation, infection, iatrogenic, neoplasm, vascular disease, or trauma. Among these, however, fungal sinusitis is one of the more rarely reported etiologies. Infections of the sphenoid sinuses typically occur in conjunction with other paranasal sinuses, while isolated sphenoid sinusitis is uncommon. In this case report, we describe OAS due to isolated sphenoid fungal sinusitis in a 67-year old man who presented with periorbital pain, acute vision loss, and ophthalmoplegia. He was treated surgically and was given postoperative antifungal agents as well as steroids for three months. We present this rare case along with a literature review of OAS.

Orbital Apex Syndrome Related to Isolated Sphenoid Fungal Sinusitis

Orbital apex syndrome (OAS) has been described as malfunction of cranial nerve II in the optic canal and cranial nerves III, IV, V1, and VI in the superior orbital fissure due to vascular compromise, compression, or infiltration. Symptoms include ophthalmoplegia, ptosis, decreased corneal sensation, and vision loss. There are many potential causes of OAS including inflammation, infection, iatrogenic, neoplasm, vascular disease, or trauma. Among these, however, fungal sinusitis is one of the more rarely reported etiologies. Infections of the sphenoid sinuses typically occur in conjunction with other paranasal sinuses, while isolated sphenoid sinusitis is uncommon. In this case report, we describe OAS due to isolated sphenoid fungal sinusitis in a 67-year old man who presented with periorbital pain, acute vision loss, and ophthalmoplegia. He was treated surgically and was given postoperative antifungal agents as well as steroids for three months. We present this rare case along with a literature review of OAS.

A Case of Invasive Aspergillosis Involving the Orbital Apex and Occipital Lobe:Successful Treatment with Voriconazole

PURPOSE: To report an immunocompetent patient with more than 1-year survival after treatment with voriconazole, despite invasive paranasal sinus aspergillosis involving the orbital apex. CASE SUMMARY: A 74-year-old woman with only preexisting hypertension visited our clinic complaining of pain and immovable left eye that occurred approximately 4 days prior. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a sphenoid sinusitis with suspicious lesion involving the orbital apex of the left eye. A biopsy by functional endoscopic sphenoid surgery (FESS) was performed through the sphenoid sinus, which enabled us to diagnose aspergillosis. The patient had esotropia, ophthalmoplegia, positive RAPD, and ptosis in the left eye. On follow-up, a new MRI showed acute to subacute stage infarction at the left occipital lobe. After the patient was treated with intravenous voriconazole, ptosis, and ophthalmoplegia improved. At the 13-month follow-up, she was alive with no disease recurrence. CONCLUSIONS: Invasive aspergillosis of orbit and cerebrum in healthy patients is a rare clinical entity. In case of central nervous system involvement, the survival outcome is poor with high mortality; however, good results can be obtained by treatment with voriconazole.

Biofilmes: causa del manejo refractario de la rinosinusitis crónica / Biofilms causing the refractory management in chronic rhinosinusitis

Introducción: Aunque muchos pacientes con rinosinusitis crónica (RSC) mejoran luego del tratamiento médico o quirúrgico, existe una subpoblación que la padece y en la que se torna recalcitrante. Esta inflamación persistente es compatible con el perfil de una infección por biofilmes. Objetivos: Ha habido un interés creciente en el estudio de biofilmes como factor principal en las infecciones crónicas. El propósito de este artículo es revisar la literatura disponible sobre rinosinusitis crónica y biofilmes. Metodología: Revisión de la literatura pertinente que se obtuvo con la búsqueda selectiva de las siguientes bases de datos: Science Direct, Pubmed y Scielo. Se realizó búsqueda entre los años 2000 y 2012. Se analizaron los resúmenes y se escogieron los textos completos que trataban sobre biofilmes y rinosinusitis crónica. Resultados: Se revisaron 34 artículos completos que se ajustaban a las exigencias de los objetivos. La evidencia científica actual relaciona los biofilmes con el desarrollo y la persistencia de la enfermedad rinosinusal crónica, con la presencia de pólipos y con pobres resultados posquirúrgicos. Conclusiones: Aun cuando la evidencia parece ser convincente en cuanto al papel de los biofilmes en la rinosinusitis crónica, todavía se necesitan estudios acerca de por qué algunos pacientes forman biofilmes, qué causas aceleran su formación, cómo prevenirlos y cómo tratarlos..…

Introduction: Although many patients with chronic rinosinusitis (CRS) improve after medical or surgical treatment there is a subpopulation of patients with recalcitrant CRS. The persistence of chronic rhinosinusitis is compatible with the profile of a biofilm infection. Objectives: Recently, there has been increased interest in bacterial biofilms as a major factor in chronic infections. The purpose of this review is to summarize the literature available on chronic rhinosinusitis and biofilms. Methods: Review of relevant literature was made through a selective search of the following databases: SciELO, Science Direct. Our search was conducted from 2000 to 2012. We reviewed abstracts then obtained the complete papers for in-depth review. Results: We reviewed 34 papers that fit our objectives. Current scientific evidence favors hypotheses postulated to relate biofilms with the persistence of chronic rhinosinusitis, the development of nasal polyposis, and poor postoperative results. Conclusions: Although the evidence seems to be convincing about the role of biofilms in chronic rhinosinusitis, many studies are lacking on why do some patients form biofilms, what triggers biofilm formation, how can we prevent them from forming and how to treat them…

The management of 53 non-pituitary lesions in sphenoidal sinus by transnasal endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnosis and management of non-pituitary lesions in sphenoidal sinus.@*METHOD@#All cases with non-pituitary lesions in sphenoidal sinus were confirmed by CT scan. Eight cases with localized lesions underwent operation by trans-sphenoidal approach. Two cases with juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus were treated by trans-septal approach. The rest received operation by trans-superior meatal or trans-ethmoidal approach.@*RESULT@#Forty-five of these cases underwent complete or major resection of the lesion by endoscopic sphenoid sinus surgery, including 23 cyst and pus cyst of sphenoidal sinus, 8 fungal sphenoid sinusitis, 2 bleeding polyp of sphenoidal sinus, 1 post- hypophysectomy granulation hyperplasia of sphenoidal sinus , 5 papilloma of sphenoid sinus, 1 cerebrospinal rhinorrhea of sphenoid sinus, 2 ossified fibroma of sphenoid sinus,2 juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus, 1 meningioma of ethmoid and sphenoid sinus. Three cases with hematoma in sphenoidal sinus and pseudoaneurysm in internal carotid artery underwent nasal endoscopic examination, and the diagnosis was established by DSA, and they received interventional therapy. Three cases with malignancy of sphenoidal sinus received major mass resection of sphenoidal sinus by trans-ethmoidal approach, and followed with radio therapy and chemotherapy. Two cases with NPC involving sphenoidal sinus were treated by radio therapy and chemotherapy after pathological examination.@*CONCLUSION@#Headache and visual loss were two common symptoms for the lesions in sphenoidal sinus. Imaging study including CT, MRI and DSA is very important for the diagnosis of the lesions in sphenoidal sinus. There are various surgical pathways to deal with sphenoidal sinus diseases under nasal endoscope. The operation will be direct, safe and minimal invasive if we choose the pathway properly.

Diagnosis and management of the acute attack of sphenoid and ethmoid fungal ball sinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features.@*METHOD@#Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy.@*RESULT@#The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms.@*CONCLUSION@#Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.

Intracavernous Sinus Arachnoid Cyst Confused with the Complication of Mycotic Sphenoidal Sinusitis / 대한이비인후과학회지

The arachnoid cyst is a rare disease that accounts for about 1% of the intracranial mass. The etiology of arachnoid cyst is due to either congenital compromise of arachnoidal development or acquired inflammatory reaction or trauma in the subarachnoid space. Computed tomography of arachnoid cyst demonstrates well-marginated low density lesions, whereas magnetic resonance image shows identical signal intensities of cerebrospinal fluid on T1 and T2 weighted image and low signal intensity on diffuse weight imaging without contrast-enhancement. The treatment of intracavernous sinus arachnoid cyst must be tailored to each patient according to the location of the lesion within cavernous sinus and the patient's symptoms. We experienced a case of arachnoid cyst of the cavernous sinus accompanying mycotic sphenoidal sinusitis. There are no previously reported cases of patients with an intracavernous sinus arachnoid cyst accompanying mycotic sphenoidal sinusitis.