Pneumosinus Dilatans Research Articles

Endonasal Operative Corridor Expansion by Sphenoidal Pneumosinus Dilatans in Tuberculum Sellae Meningiomas.

A retrospective cohort study of patients with tuberculum sellae meningioma (TSM)-associated sphenoidal pneumosinus dilatans (PSD) over a recent epoch was evaluated using a propensity-matched morphometric analysis. A total of 38 patients with TSM and sphenoidal PSD were identified and matched by age and sex to 32 patients without tumors (controls). Overall, no significant difference between test and control groups was noted in sphenoid sinus size or other parameters; however, significantly greater mean distances from the posterior margin of the planum sphenoidale to the diaphragma sella (0.76 ± 0.23 vs. 1.03 ± 0.27, respectively; P= 0.0001) and angle between the planum sphenoidale to anterior face of sella turcica (113.41 ± 10.58 vs. 123.21 ± 12.55, respectively; P= 0.001) were seen in patients with TSM and PSD, suggestive of a selective expansion of the tuberculum sellae region. TSM/sphenoid sinus morphologies were divided into 3 types (A, B, and C) based on the extent of tumor and sinus morphology. There was progressive increase in tumor volume and anteroposterior sinus diameter from sphenoidal PSD types A-C, which influenced selection of surgical approach. This study suggests that TSM-associated sphenoidal PSD leads to more selective splaying of the tuberculum sellae region rather than cumulative increase in sinus volume. This may lead to operative corridor expansion for endonasal access to TSMassociated with sphenoidal PSD. A radiologic classification scheme for sphenoidal PSD associated withTSM is suggested that may aid surgical decision-making.

Pneumosinus dilatans of the spheno-ethmoidal complex associated with hypovitaminosis D causing bilateral optic canal stenosis

Pneumosinus dilatans (PSD) is a rare disorder of undetermined etiology characterized by expansion of the paranasal sinuses without bony erosion. Of the few cases of PSD described in indexed pediatric literature, there has been no reported case of this disorder presenting with optic canal stenosis in the setting of a vitamin deficiency. A 12-year-old girl presented with a 3-month history of progressive, painless, and asymmetric visual deterioration in her eyes. MRI showed prominent perioptic CSF spaces bilaterally and mild atrophy of both the optic nerves. CT head showed hyperpneumatization of the sphenoethmoidal air cells and both anterior clinoid processes with the optic nerves contained within narrowed intact bony canals. Blood investigations showed reduced vitamin D levels, and a subsequent skeletal survey showed diffuse osteopenia. She underwent endoscopic sphenoidotomy and bilateral decompression of the optic nerves. Following surgery, she reported improvement of vision in her left eye. She was started on vitamin D supplements for the endocrine abnormality. At a follow-up visit 6months later, her visual acuity in both her eyes had improved. Pneumosinus dilatans is an unusual cause of progressive optic nerve dysfunction in the pediatric population. In the absence of any associated intracranial pathologies, conditions like hypovitamosis D should be ruled out.

Pneumosinus dilatans of frontal sinuses: cosmetic deformity treatment

Pneumosinus dilatans of frontal sinuses: cosmetic deformity treatment

Pneumosinus Dilatans: Over 100 Years Without an Etiology

Pneumosinus dilatans (PD) is a rare pathologic hyperaeration of the paranasal sinuses that causes serious deformation of the overlying bone and soft tissue. The condition occurs most commonly in the frontal sinus of young men who present with different complaints, including cosmetic. More than 100 cases have been reported in the literature since it was first described in 1898; however, the etiology of this condition remains unclear. A systematic review of all available clinical publications on the subject of PD was conducted in the PubMed electronic database. The resultant articles were grouped based on evidence supporting or refuting various theoretical etiologies to further characterize the condition. In total, 134 known cases were reported in 117 articles. Most affected patients were young men in the third decade of life. Only 19 (16.2%) articles offered some form of evidence in support of a particular etiology. The most substantiated etiologies of PD included a "ball-valve" mechanism of sinus outflow obstruction leading to air trapping or a primary fibro-osseous pathologic process that disrupts the cellular milieu. Less substantiated theories included hormonal dysregulation or a spontaneously draining mucocele. No data exist to support causation by gas-forming bacteria. A bimodal distribution of incidence, a younger population (16 to 25yr), and an older population (36 to 40yr) might suggest multiple possible etiologies. Several theories on the etiology of PD exist, but none have been substantiated by reliable scientific evidence. Standardizing the clinical evaluation, classification, management, and pathologic analysis of patients with PD could aid in elucidating its true etiology.

Isolated Pneumosinus Dilatans of Maxillary Sinus Combined with Generalized Hypersinus: An Atypical Cause of Acute Facial Pain

Pneumosinus dilatans is a rare disease of unknown etiology characterized by expansion of 1 or more paranasal sinuses. The lesion includes an abnormal enlargement of the sinus cavity, but no evidence of bony destruction or pathological changes of the underlying mucosa. In some reports the symptoms involve compression of the optical nerve and associations with meningiomas or arachnoidal cysts. Osteoplasty or decompression surgery seem to be the only effective treatments

Bilateral pneumosinus dilatans of the sphenoid sinuses causing visual loss

Abstract The purpose of this paper is to discuss the rare presentation of pneumosinus dilatans (PDS) of the sphenoid sinuses in a pediatric patient manifesting as acute visual loss, and his successful treatment with surgical intervention. A total of 29 cases of sphenoid sinuses in the literature were reviewed. 11 patients (37.93%) were classified as having idiopathic disease. 22 patients (75.86%) presented with visual loss as their chief complaint. All 3 patients with idiopathic PDS that underwent sphenoidotomy had resolution of their symptoms. When symptomatic sphenoid sinus PDS is diagnosed, endoscopic sphenoidotomy should be considered as primary treatment.

Pneumosinus Dilatans

Pneumosinus dilatans (PD) is a pathologic condition involving the hyperaeration of one or several of the paranasal sinuses that can lead to significant deformation of the overlying bone. Although the presenting complaint of patients with PD is most commonly aesthetic in nature, the condition has also been associated with intracranial tumors and several other serious conditions. A meta-analysis of all available clinical publications on the subject of PD was conducted. Patients were categorized on the basis of their sinus involvement. Associated conditions were also identified and categorized. The resulting data were used to further characterize the condition and describe previously unreported associations between PD and other conditions. To date, a total of 123 cases of PD have been reported. The frontal sinus was the most commonly involved (63%), followed by the sphenoid sinus (24%), maxillary sinus (20%), and ethmoid sinus (19%). Of patients with symptomatic PD of the frontal sinus, 25% had intracranial pathology (meningioma or arachnoid cyst or orbital tumor). Patients with sphenoid PD had an 83% chance of having associated diagnosis of visual loss, meningioma, or arachnoid cyst, whereas patients with ethmoid PD had 83% chance of having associated diagnosis of exophthalmos, vision loss, or arachnoid cyst. Although the presenting complaint of patients with PD is most commonly aesthetic in nature, a significant percentage may have an associated diagnosis. Health care providers must be able to recognize the condition and carry out the appropriate clinical evaluation to avoid missing an associated diagnosis.

Is pneumosinus dilatans an osteogenic disease that mimics the formation of a paranasal sinus?

Pneumosinus dilatans is a disease that produces an abnormal expansion of a paranasal sinus cavity, which contains only air and is lined by normal mucosa, and whose bony walls are displaced outwardly to cause facial embossing or intracranial, orbital or ethmoidal encroachment. Objective was to evaluate the hypothesis that pneumosinus dilatans is primarily an osteogenic disease. A detailed clinical history of three consecutive patients with pneumosinus dilatans was taken. Each patient also underwent computed tomography (CT), fluorine-deoxyglucose positron emission tomography-CT (FDG PET-CT), fluorine 18-labeled sodium fluoride PET-CT (NaF PET-CT), and bone pathology. The FDG PET-CT and pathology confirmed that the mucosa inside the pneumosinus dilatans was normal and devoid of inflammatory cell infiltrate. Significant uptake of (18)F-NaF on PET-CT images correlated well with bone pathology, showing intense and diffuse bone remodeling. At a 1-year follow-up, following a frontotomy for case #1 and a middle antrostomy for case #2, there was a marked resolution of the patients' clinical symptoms and deformities, new bone formation on the walls, stabilization of the new sinus shape and volume, and persistence of significant uptake of (18)F-NaF. Pneumosinus dilatans is a rare disease. Its diagnosis is based on CT scan images. This study has shown that (18)F-NaF PET-CT and bone pathology are useful modalities for the positive diagnosis of difficult cases. Pneumosinus dilatans appears to be an osteogenic disease. Further research is needed to investigate a possible link between mechanisms involved in paranasal sinus formation and those involved in pneumosinus dilatans.

Reduction osteoplasty for treating pneumosinus dilatans of the maxillary sinus

To report a patient with maxillary pneumosinus dilatans and facial deformity treated by reduction osteoplasty and reconstruction. This study describes the successful management of facial deformity in a 17-year-old male with maxillary pneumosinus dilatans. The patient's facial deformity of the maxillary sinus, which had been slowly progressing over a 10-year period, was managed by reduction osteoplasty and reconstruction using the maxillary bone, conchal cartilage and Tutoplast-processed fascia lata via a sublabial approach. This treatment yielded satisfactory functional and aesthetic outcomes. As pneumosinus dilatans of the maxillary sinus is uncommon, there is no established surgical treatment protocol. This surgical technique was less invasive than other described procedures and revealed good cosmetic results.

Bilateral Pneumosinus Dilatans of the Maxillary Sinuses with Facial Pain

Pneumosinus dilatans is a rare disease in which 1 or more paranasal sinuses are dilated without functional alteration. The frontal sinus is the most commonly affected site, with involvement of the maxillary sinus being rare. A 25-year-old man had complained of facial pain and headache of frontal area. These symptoms were aggravated after nose blowing. A computed tomographic scan showed a hyperaeration of both maxillary sinus and frontal sinus. We treated the condition by endoscopic sinus surgery (middle meatal antrostomy, both). Just after operation, facial pain and headache of frontal sinus have subsided. No recurrence was detected. In this article, the authors present surgical options for the treatment of pneumosinus dilatans of the maxillary sinus, including a review of the literature. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:233-6

Pneumosinus dilatans in anterior skull base meningiomas

Skull base meningiomas are often missed on non-contrast CT or MR examinations due to their close proximity to bone and low lesion to brain contrast. The purpose of this study is to illustrate that pneumosinus dilatans can be an indicator of anterior skull base meningiomas. A retrospective search of the radiology information system and picture archiving and computing system database was performed. Search terms were "meningioma" in association with "pneumosinus dilatans." Medical records and imaging studies were reviewed independently by two experienced neuroradiologists and were read in consensus. We recorded the patient age at the time of discovery of the meningioma, main presenting symptom(s), location of the tumor, and imaging characteristics. We also performed a comparative literature search for pneumosinus dilatans and its association with meningiomas. Ten patients (six women; four men) were identified in whom a meningioma of the anterior skull base was associated with a pneumosinus dilatans. Three patients had multiple meningiomas, so a total of 14 intracranial tumors were identified. Mean age at discovery was 59 years with an age range of ± 20years. All meningiomas were diagnosed by MRI and/or CT. Pneumosinus dilatans can be a helpful sign to indicate the presence of a meningioma of the anterior skull base.

Craniofacial surgical strategies for the correction of pneumosinus dilatans frontalis

IntroductionPneumosinus dilatans is a rare condition and different techniques have been proposed for its management and correction.The abnormally expanded, aerated frontal sinus has been described in the literature as: frontal sinus hypertrophy, pneumosinus dilatans, pneumosinus frontalis, aerocele, pneumocele, sinus ectasia, hyperpneumatization and others. The precise aetiology and pathogenesis of the condition is unknown, although several basic hypotheses have been proposed Material and methodsThe authors report two cases of frontal bossing and supraorbital ridge deformity correction using craniofacial surgical principles. DiscussionFunctional and morphological results are discussed and compared with other open procedures. ConclusionA variety of surgical procedures have been proposed for the correction of the pneumosinus dilatans frontalis. The craniofacial approach is advocated to reproduce the normal anatomy of the forehead in the upper part, the supraorbital rim and glabellar area.

Frontal Sinus Pneumosinus Dilatans Combined with Excessive Aeration of All Paranasal Sinuses and Mastoid Air Cells

Objective: To report a case of a patient with chronic headache associated with pneumosinus dilatans of the frontal sinus, as well as excessive aeration of the rest of the paranasal sinuses and mastoid air cells.

Surgical Management of Pneumosinus Dilatans Frontalis in the Setting of Chronic Rhinosinusitis and Type III Frontal Cell

Pneumosinus dilatans (PD) represents a rare lesion of unknown etiology in which progressive enlargement of an air-filled paranasal sinus results in cosmetic and functional complications. The absence of pathologic mucosa has traditionally been considered a hallmark of this disorder. A 24-year-old man presented with 2 years of chronic rhinosinusitis and recurrent, acute episodes of severe forehead pain with worsening outward prominence of the frontal sinus during air travel. Computed tomography and findings at surgery were notable for diffuse nonpolypoid inflammatory changes of the paranasal sinuses, a type III frontal sinus cell, and PD of the frontal sinus with severe deformity and thinning of the anterior table. A bicoronal approach was used for frontal sinus obliteration and cranioplasty. Excellent cosmetic and functional results were noted at the last follow-up. To our knowledge, this is the first report of PD frontalis presenting in the setting of chronic rhinosinusitis. Surgical management of this disorder requires consideration of both the functional and cosmetic issues.

Pneumosinus dilatans, pneumocoele or air cyst? A case report and literature review

Pathological paranasal sinus expansion secondary to air is uncommon. However, this condition may be symptomatic or cosmetically apparent, requiring surgical intervention. Various terms have been used to describe this condition, and nomenclature is controversial. An 18-year-old man presented with right facial pain, and was subsequently found to have pneumosinus dilatans of the maxillary sinus. A search was conducted of the PubMed, Medline and Embase databases, using the key words 'pneumosinus dilatans', 'pneumoc(o)ele', 'pneumatoc(o)ele' and 'maxillary sinus'. Articles were also hand-searched. Relevant articles published in English were reviewed. The literature review identified 36 cases involving the maxillary sinus (including the present case), with 19 cases reported as pneumosinus dilatans, 12 as pneumocoeles, two as pneumatocoeles, two as pneumosinus dilatans multiplex and one as an air cyst. However, based on the strict classification described by Urken et al., the majority of these cases should be reclassified as pneumocoeles. Whilst the nomenclature of this pathology is confusing, distinctions of terminology do not alter the management. Hence, we support the use of the term 'air cyst', to incorporate all these lesions.

Pneumosinus dilatans of the maxillary sinus: a case report and review of the literature

Pneumosinus dilatans of the maxillary sinus: a case report and review of the literature

Surgical Correction of Pneumosinus Dilatans of Maxillary Sinus

Pneumosinus dilatans is a rare disease in which 1 or more paranasal sinuses are dilated without functional alteration. The frontal sinus is the most commonly affected site, with involvement of the maxillary sinus being rare. Asymmetrical facial contour is the most common sign, and nasal obstruction and pain may also be present. We describe 6 cases of maxillary pneumosinus dilatans with histories of protrusion of the malar region. Plane radiography and computed tomography revealed abnormal expansion of the maxillary sinus without thinning of the bony wall, leading to a diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by electrical burring, greenstick downward fracture, or ostectomy of the anterior wall of the maxillary sinus and subsequent repositioning of the removed bony fragments with miniplates. The postoperative course was uneventful, and facial contours were improved on physical and radiologic examination. No recurrence was detected in any case, and good cosmetic results were achieved. In this article, the authors present surgical options for the treatment of pneumosinus dilatans of the maxillary sinus, including a review of the literature.

Pneumosinus Dilatans and Hypercalcification of the Falx and Ligamentum Petroclinoideum in Myotonic Dystrophy 1

Pneumosinus dilatans (PSD) is a rare condition characterized by abnormally enlarged aerated sinuses, but normal thickness and preserved integrity of the sinus walls. PSD occurs most commonly in young men. Its etiology remains elusive but has been associated with various conditions, such as hydrocephalus, trauma, Dyke-Davidoff syndrome, meningocele, arachnoidal cyst, meningioma, neurofibromatosis 2, and neurolemmoma. PSD has not been reported in myotonic dystrophy type 1 (MD1). We present a 43-year-old man with MD1 because of a CTG-expansion of 1333 repeats in the DMPK gene. A computed tomography scan of the cerebrum, carried out for assessment of central nervous system involvement in MD1, surprisingly demonstrated PSD. Because PSD was asymptomatic no surgical treatment was recommended to the patient. Whether PSD was a manifestation of MD1 or a mere coincidence remains elusive. This case shows that PSD may occur together with MD1. Whether this association is causal or coincidental remains to be elucidated. It also remains speculative whether PSD contributes to the facial dysmorphism frequently present in MD1 patients. If PSD becomes symptomatic surgical intervention should be considered.

The relation of port wine stain with pneumosinus dilatans: A controlled study

The relation of port wine stain with pneumosinus dilatans: A controlled study

Spontaneous Pneumocephalus Associated with Pneumosinus Dilatans

The majority of cases of pneumocephalus are secondary to trauma or medical intervention. Spontaneous, non-traumatic pneumocephalus is an uncommon condition. Most cases of spontaneous pneumocephalus require surgery. However, if there is no evidence of infection or cerebrospinal fluid leak, bed rest and follow-up imaging is an alternative treatment. Herein, we report a 31-year-old man with spontaneous pneumocephalus associated with pneumosinus dilatans.