Syndrome Associated with Mucocele of the Sphenoid Sinus

Abstract

The diagnosis of mucocele of the sphenoid sinus is usually made at autopsy or at surgery, when a transdural procedure often leads to a fatal meningitis. In the majority of reported cases, radiologic examination was not carried out; in those in which such examination was performed, it was inadequate or the findings were not appreciated. Until recent French publications (1–3), there were few, if any, detailed radiographic descriptions of sphenoid mucocele in the literature. In 1946, Linthicum and his associates (4) estimated that not more than 25 cases of mucocele of the sphenoid sinus had been reported, and they described the autopsy findings in an additional case. A review of the literature since their report reveals 3 cases (1, 5, 6) and possibly a fourth (7). Two additional cases, with radiographic findings follow. Case Summaries Case I: A 58-year-old white woman was first seen on July 23, 1947, with a history of decreasing vision and floating spots in the left eye. The vision in the left eye was noted to fluctuate spontaneously, while the right eye was affected to a milder degree. For a year and a half the patient had experienced an almost constant headache mainly confined about the left eye. The sense of smell was not affected. On admission vision was O.D. 3/12, O.S. 3/60, correctable to O.D. 3/5, O.S. 3/12. Eye diagnosis was optic neuritis with retinitis on the left. Complete neurologic examination showed no abnormalities except for vision. Roentgen studies of the skull were reported as follows: “Anteroposterior diameter of the sella turcica is 16 mm., and the vertical diameter is 12 mm.; the floor of the sella is thin; and the posterior clinoids are thin and appear tilted upward.” The x-ray diagnosis was “changes in sella turcica consistent with pituitary adenoma.” The patient was next seen one year later. Vision in the left eye had continued to fluctuate from none at all to recognition of hand movements. Frequent left-sided headaches were still present. Eye diagnosis was “secondary optic atrophy, left.” The third visit was on Dec. 22, 1950, three and a half years after initial examination. One year before this visit the patient had noted the onset of left nasal obstruction with mucopurulent nasal discharge and a loss of the sense of smell. On Oct. 29, 1950, she had undergone surgery for the nasal obstruction and had been told that the growth in her nose was only partially removed. At that time about an ounce of brown mucoid fluid was obtained, which was reported as “degenerated tissue” by the local pathologist. Since the operation the patient had experienced two episodes of swelling and protrusion of the left eye and there had been a constant blood-tinged left nasal discharge. Examination now showed complete anosmia, total blindness on the left, with exophthalmos, and a mass obliterating the left choana. Biopsy of the left intranasal tumor was attempted on Dec. 27, 1950, shortly after the patient's third visit.