Sphenoid Sinus Lesions Research Articles

Isolated sphenoid sinus lesion: A diagnostic dilemma

Isolated sphenoid sinus lesion: A diagnostic dilemma

Glial Heterotopia of Sphenoid in Association with a Patent Sternberg's Canal presenting with Meningitis

ABSTRACTEctopic glial tissue, presenting at various sites of body is a rare embryonic developmental anomaly. Very few cases are reported in adults, most being incidentally detected, revealed only by histopathological findings. One of the rarest locations is the sphenoid sinus.We present here the case of a middle aged female, presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea and meningitis. With the radiological finding of a soft tissue density in sphenoid sinus with erosion of left temporal skull base, she underwent lateral craniotomy, with excision of the mass and middle cranial fossa floor repair. Histopathology revealed a heterotopic glial tissue. Peroperative finding of a well-defined defect in the lateral wall of an extensively pneumatized sphenoid showed typical features of a patent Sternberg's canal.This case could be a living proof for the existence of this rare developmental anomaly. A persisting Sternberg's canal should be considered as the source of spontaneous CSF leaks with or without lesions in sphenoid sinuses with extensive lateral pneumatization. Most of the cases may be treated with an extended endoscopic approach. Extreme lateral lesions like this would benefit most from a craniotomy approach for proper closure of skullbase defect. Three years after successful surgery, she remains symptom free.How to cite this articleSuma R, Jeena KJ, Pavithran VM, Govindan A, Ramachandran K. Glial Heterotopia of Sphenoid in Association with a Patent Sternberg's Canal presenting with Meningitis. Int J Otorhinolaryngol Clin 2014;6(2):81-83.

前立腺癌の蝶形骨洞転移例

We experienced a patient with sphenoid sinus metastasis from prostatic adenocarcinoma. A 75-year-old man suffering from diplopia for one month was diagnosed as having left abductor paralysis by an ophthalmologist. He was referred to our department, because the cause of the left abductor paralysis was suspected as being due to opacification at the bilateral sphenoid sinus seen on CT imaging. We performed a nasal septoplasty and endoscopic sinus surgery (ESS) under local anesthesia. A reddish brown tumor in the sphenoid sinus was bilaterally observed during surgery. The tumor was histologically diagnosed as an adenocarcinoma metastasized from prostatic cancer. The left abductor paralysis gradually improved following treatment by medical oncologists after chemotherapy using docetaxel. Sinonasal CT imaging also showed a reduction of the tumor volume in the sphenoid sinus lesion. However, the patient re-presented with right facial palsy in the seventh month after surgery. Finally, he died of respiratory dysfunction caused by metastatic cancer to the lung.

Analysis of sphenoid sinus in the operative plane of endoscopic transsphenoidal surgery using computed tomography

Recently, the endoscopic transsphenoidal approach for sphenoid sinus or intracranial lesion has gained more popularity and the study of the surgical anatomy and relationships of the sphenoid sinus has gained increased significance. The aim of this study was to clarify the anatomical features of the sphenoid sinus including surrounding structures as seen in the operative view of endoscopic transsphenoidal surgery. The various distances in the sphenoid sinus as well as the relationships between the sphenoid sinus ostium (SO) and important structures such as the optic canal (OC) and carotid artery (CA) according to the presence of Onodi cell (sphenoethmoidal cell; Onodi group vs. non-Onodi group) were assessed using multiplanar and three-dimensional model of CT scans in 100 patients. The SO was more inferior in Onodi group and located superior to the lowest point of the sella. The horizontal distance from the SO to sella was approximately 13 or 14 mm depending on the existence of Onodi cells. Regardless of Onodi cell, the whole course of the OC in the sinus ran superolaterally to inferomedially in the endoscopic view. However, Onodi cell made the angles from the SO to OC larger. In Onodi group, the CA was located from the SO in a superolateral direction, but in non-Onodi group, the CA was located from the SO in the inferolateral direction. This study provides anatomical information about the sphenoid sinus, with important surgical distances between the SO and surrounding structures measured, which is essential to avoid complications during transsphenoidal surgery.

Sinolith

Sinolith is a calculus in the paranasal sinuses. It has been also known as antrolith, rhinolith, antral calculi, antral stone, or antral rhinolith. The pathogenesis of calculi formation within a paranasal sinus is still not known. Chronic infection, foreign material, poorly draining sinus, and fungal infection are the main predisposing factors. Isolated sphenoid sinus lesions are rare, and most of them are inflammatory diseases. The main symptom of sphenoid sinus lesions is headache. Headache may be the only symptom of sphenoid sinus lesions. Sinolith is mostly encountered in the maxillary sinus followed by the frontal sinus and the ethmoid sinus. There was only 1 publication about sinolith localized in the sphenoid sinus in the English language literature. We report a case of an isolated sinolith localized in the sphenoid sinus. The treatment of choice should be surgical removal of the sinolith. Endoscopic surgery especially through the transnasal route should be the first-choice surgical treatment of isolated sphenoid sinus lesions.

Glial Heterotopia of Sphenoid in Association with a Patent Sternberg's Canal presenting with Meningitis

ABSTRACT Ectopic glial tissue, presenting at various sites of body is a rare embryonic developmental anomaly. Very few cases are reported in adults, most being incidentally detected, revealed only by histopathological findings. One of the rarest locations is the sphenoid sinus. We present here the case of a middle aged female, presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea and meningitis. With the radiological finding of a soft tissue density in sphenoid sinus with erosion of left temporal skull base, she underwent lateral craniotomy, with excision of the mass and middle cranial fossa floor repair. Histopathology revealed a heterotopic glial tissue. Peroperative finding of a well-defined defect in the lateral wall of an extensively pneumatized sphenoid showed typical features of a patent Sternberg's canal. This case could be a living proof for the existence of this rare developmental anomaly. A persisting Sternberg's canal should be considered as the source of spontaneous CSF leaks with or without lesions in sphenoid sinuses with extensive lateral pneumatization. Most of the cases may be treated with an extended endoscopic approach. Extreme lateral lesions like this would benefit most from a craniotomy approach for proper closure of skullbase defect. Three years after successful surgery, she remains symptom free.

Optimal Approach to the Sphenoid Sinus: The Missed Guide

Objective: To formulate an updated applicable algorithm for selection of the optimal surgical approach to the sphenoid sinus. Method: Retrospective review. The records of 63 patients who had undergone surgery for sphenoid sinus lesions, at Otolaryngology Department, Tanta University, between 2000 and 2009 were reviewed. Four different surgical approaches were identified: Endoscopic transnasal sphenoidotomy (TNS), endoscopic transethmoidal sphenoidotomy, endoscopic transpterygoid sphenoidotomy, and endoscopic transnasal sphenoidotomy with posterior septectomy. The approaches were compared in: mean age, preoperative imaging data, pathological diagnosis, percentage of revision procedures, and surgical complications. Results: TNS was the most commonly used approach (65%). Endoscopic transethmoidal sphenoidotomy was the second approach (25%). Endoscopic transpterygoid sphenoidotomy was used in 3%. It was used for management of lateral sphenoid recess lesions. Endoscopic transnasal sphenoidotomy with posterior septectomy was used in 6% for sellar, parasellar, and clival lesions. No major complications were committed. Conclusion: Selection of the appropriate approach to the sphenoid depends mainly on the disease extent displayed by preoperative imaging. The endoscopic transnasal approach was suitable for management of isolated sphenoid sinus lesions. Eendoscopic transethmoid approach was used for management of pansinus involvement. The endoscopic transpterygoid approach was used for dealing with lesions of the lateral sphenoid recess and the endoscopic transnasal sphenoidotomy with posterior septectomy was used for management of sellar, parasellar, and clival lesions.

Hepatocellular Carcinoma Presenting as An Isolated Sphenoid Sinus Lesion: A Case Report

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.

Sensitivity and specificity of computed tomography and magnetic resonance imaging in the diagnosis of isolated sphenoid sinus diseases

The sphenoid sinus is uncommonly affected by inflammatory or neoplastic lesions. Initial onset of isolated sphenoid sinus diseases (ISSD) is generally asymptomatic. The objectives of this study were to estimate the sensitivity and specificity of computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing ISSD and establish guidelines to declare hidden ISSD through correlation of radiological diagnosis to final pathological diagnosis. A prospective cohort study. There were 66 patients with isolated sphenoid sinus lesions presenting to Ain-Shams University Hospitals, Cairo, Egypt. Provisional diagnosis of ISSD was done by CT and MRI, followed by histopathologic and immunohistochemical staining, and if needed microbiological examination of resected specimens to establish the final diagnosis. Patients were classified into four groups according to the type of lesion: inflammatory, neoplastic, bony dysplastic disorders, and sphenoid sinus roof defect-related lesions. Radiological imaging provided the greatest diagnostic information and guided management. The sensitivity of CT and MRI in diagnosing inflammatory lesions was 95% versus 61%, whereas those of the neoplastic group were 72% and 100%, respectively. In the osseous group the sensitivity was 100% for both CT and MRI, whereas in sphenoid sinus roof defect the sensitivity was 50% and 100% for CT and MRI, respectively. Because of CT's superiority in defining the bony margins and MRI's superior soft tissue resolution, CT and MRI should be used in a complementary manner in the evaluation of isolated sphenoid sinus disease in addition to mapping the lesion better and identifying intracranial and intraorbital extension. The use of one modality only should be restricted to straightforward lesions.

Varied Ophthalmic Presentations in Sphenoid Sinus Lesions

ABSTRACT Sphenoid sinus lesions can present with a multitude of symptoms/signs including ophthalmic disturbances. We describe a total of five patients, of which two had mucoceles and rest three had fungal infection. Ophthalmic symptoms/signs were the ones we were really interested in. We also present one case which had isolated sphenoid fungal sinus. We also give details of their presentation, investigations and treatment. Possible ocular manifestations of mucoceles and the diagnostic imaging techniques used are discussed. The treatment of mucoceles is reviewed. It is stressed that a team approach involving the ophthalmologist, otolaryngologist and radiologist is essential for accurate diagnosis and management.

Endoscopic transphenoidal approach for fibrous dysplasia of clivus, tuberculum sellae, and sphenoid sinus; report of three cases

Fibrous dysplasia is a benign disease in which medullary bone is replaced by fibro-osseous tissue, and causes distortion and overgrowth of the involved bone and represents about 3% of all bone tumors. There is variability in the manifestation of Fibrous Dysplasia lesions with imaging techniques due to their proportional variations of fibrous to osseous tissue. Radiological differential diagnoses include meningioma, chordoma on MRI and Paget disease on CT imagings. We report three cases of monostotic fibrous dysplasia, affecting clivus, tuberculum sellae, and sphenoid sinus through the pterygopalatine fossa. We performed pure endoscopic transphenoidal approach for those three cases with the guide of neuronavigation. Extended approach was used via binostril for fibrous dysplasia of clivus and Tuberculum sellae. Radiologic report revealed chordoma and meningioma for the two cases and fibrous dysplasia for the last case. Total resection of tuberculum sellae, subtotal resection of clivus and partial resection of sphenoid sinus lesions were performed. Pathology diagnosis were fibrous dysplasia in all three patients. Histopathological sampling provided by surgical approach should be obtained to establish the final diagnosis. Endoscopic approaches are convenient for skull base lesions even for biopsy or curative resections providing panoramic view and avoid brain retraction.

Wpływ leczenia endoskopowego niewielkich, izolowanych zmian zapalnych zatoki klinowej na dolegliwości bólowe głowy

One of the most frequent complaint in patients with isolated sphenoiditis is headache. In large proportion of these patients no pathologic findings are revealed in sphenoethmoidal recess endoscopicaly thus discrimination between sinus originated and primary headache in such cases may be especially difficult. Was the assessment of the influence of endoscopic treatment of isolated, small inflammatory sphenoid sinus lesions on headache sensation. 13 patients suffering from headache, with CT-diagnosed isolated, small inflammatory lesions of sphenoid sinus such as mucosal thickening, polypoid tissue and cysts were treated endoscopicaly. Headache was assessed on the basis of five-grade scale before surgery, 1 month after surgery and after the observation period that varied between 5 to 40 months. In the first postoperative month the improvement in their headache was declared by 84.6% of patients, but after longer observation the success rate lowered to 61.5%. The improvement was observed both in patient whose the only complaint was headache and in patients with negative endoscopic findings. Small isolated sphenoid sinus lesions constitute a group of specific pathologies of paranasal sinuses, which is still difficult to diagnose despite of technological advancement. The treatment of these lesions remains controversial. Decision as to operative treatment should be taken cautiously since headache in great proportion of these patient is not sinus originated. Further multicenter studies on the basis of larger group of patients are necessary to delineate the indications for surgical intervention in patients with small isolated inflammatory sphenoid sinus lesions.

A Case of Malignant Sphenoid Sinus Lymphoma with Abducens Nerve Palsy

A 73-year-old woman reporting left-eye pain, left proptosis, left abducens palsy with diplopia, headache and nausea while being treated for chronic sinusitis was found to have signs of sphenoiditis and ethmoiditis in computed tomography (CT) and magnetic resonance imaging (MRI). We conducted endoscopic sinus surgery on suspicion of orbital apex syndrome due to chronic sinusitis, finding the left sphenoid sinus to be filled with yellowish-white caseous tissue underlaid with abnormal pathologycal mucosa. Pathological examination of abnormal tissue yielded a diagnosis of diffuse large B-cell lymphoma. The lesion was considered the primary one after systemic imaging showed no other lesion. Complete remission was obtained after 6 courses of rituximab THP-COP. A primary malignant lymphoma sphenoid sinus lesion is very rare.

Incidentally Diagnosed Simultaneous Second Primary Tumor of the Sphenoid Sinus in a Patient With Lung Cancer

Synchronous tumors are described as multiple primary malignancies presenting within 6 months of diagnosis of index tumors. Synchronous tumors of the lung and the head and neck region is frequently seen. However, isolated sphenoid sinus and lung cancers are not reported yet. Here, we reported an incidentally diagnosed simultaneous second primary sphenoid sinus tumor in a patient with lung cancer. Radiological evaluation results demonstrated a significant contrast-enhanced mass in the sphenoid sinus extending through the nasopharynx because of the destruction of the sphenoid sinus. The decision was made to proceed with chemotherapy and radiotherapy treatment regimens for the sphenoid sinus lesion, and right lobectomy was performed for the lung lesion. Asymptomatic simultaneous, synchronous, or metastatic tumors must always be kept in mind, and histopathologic diagnosis should be done for both tumors because presence of second tumor anywhere may change the treatment modality.

Isolated Sphenoid Sinus Disease: Analysis of 11 Cases

Objective To evaluate the presenting symptoms, imaging data, surgical treatment, and clinical outcomes associated with isolated sphenoid sinus disease. Patients and Methods From July 2003 to February 2008, the authors performed surgery on 11 patients with isolated sphenoid sinus diseases. The presenting signs and symptoms, radiological studies, operative findings, and clinical outcomes were retrospectively reviewed and analyzed. Results Five patients presented with a fungal process, three with sphenoid sinusitis, one with mucocele, one with an angiofibroma, and one with fibrous dysplasia. The most common presenting symptom was headache, followed by rhinorrhea and visual symptoms. Ten patients were treated endoscopically and one patient was treated with an external approach. Conclusion Because of the proximity of the sphenoid sinus to important and vulnerable structures of the skull base, delay in diagnosis and treatment can lead to the development of serious intracranial and orbital complications. The presenting symptoms of patients with an isolated sphenoid sinus lesion are often vague and nonspecific, with headache being the only reliable finding. Endoscopic sinus surgery is a safe, effective, and direct approach to the sphenoid sinus.

The role of specialist lung cancer nurses in the UK: a national survey

<b>Objectives:</b> We present the first known case in the English-language literature of a myxoma arising in the sphenoid sinus. By describing the patient9s clinical course and the salient features of this rare neoplasm, we seek to increase the awareness of the presentation, histological features, and treatment considerations for myxomas of the head and neck. In the process, we intend to describe the work-up of isolated sphenoid sinus lesions and focus on the varying and evolving techniques for surgical access to the sphenoid sinus. <b>Study Design and Methods:</b> Case report and literature review. <b>Results:</b> We describe the clinical course of a patient with a myxoma of the sphenoid sinus. The patient underwent an external sphenoethmoidectomy through a lateral rhinotomy approach with medial maxillectomy under MRI-guidance. He remains without evidence of recurrent disease after 8 months. <b>Conclusions:</b> Myxomas of the head and neck are rare neoplasms. Their infiltrative nature and tendency to recur demand an aggressive surgical approach that may be accomplished with minimal morbidity using currently available image-guided techniques.

Cyclic Cushing syndrome due to an ectopic pituitary adenoma

A 39-year-old man was referred to an endocrinology clinic for evaluation of his Cushing syndrome. He had gained 20 kg over 5 years and complained of intermittent headaches and easy bruisability. His medical history included a left foot fracture associated with minimal trauma 2 years earlier, hypertension, and stable Crohn disease with no use of exogenous glucocorticoids for at least 10 years. Measurements of plasma adrenocorticotropic hormone, 24 h urine free cortisol excretion, late-night salivary cortisol, serum cortisol levels before and after corticotropin-releasing hormone administration during a dexamethasone suppression/corticotropin-releasing hormone-stimulation test, pituitary MRI, and inferior petrosal sinus sampling. Cyclic Cushing syndrome secondary to an ectopic pituitary adenoma. The cyclic nature of Cushing syndrome was suggested by the absence of hypercortisolemia during inferior petrosal sinus sampling, and was confirmed by multiple 24 h urine free cortisol measurements. The patient underwent transsphenoidal surgery, during which a 5 mm firm, round, midline sphenoid sinus lesion was identified and resected. In preoperative imaging studies, this lesion had been interpreted as being a mucosal polyp. At microscopic examination, the lesion was found to be a pituitary adenoma, which stained diffusely with antiadrenocorticotropic-hormone antibodies. Explorations of the sella and pituitary did not reveal any abnormalities. Postoperatively, the patient became hypocortisolemic and his cushingoid features resolved. His adrenal function normalized 3 months after surgery. At 18 months, the patient continued to be symptom-free with normal levels of urinary-free cortisol and midnight salivary cortisol.

Sphenoidotomia w leczeniu izolowanych chorób zatoki klinowej

The standart terms and definitions for paranasal sinuses operations were published in 2005 by Simmen and Jones. Sphenoidotomy is a surgical procedure when the natural ostium of sphenoid sinus is enlarged in varying degrees. Microscopic, endoscopic or ballon-assisted endoscopic sphenoidotomy are performed in endonasal sinus surgery and endonasal neurosurgery. This approach is considered for cases of isolated lesions of the sphenoid sinus, the sella lesions, the cerebrospinal fluid leaks into the sphenoid sinus and also for the treatment pathological conditions in the skull base. Isolated lesions of the sphenoid sinus are very rare with uncharacteristic symptoms. Headache is the most common. Vision disturbances occur occasionally. Endoscope assisted physical examination and CT scans of paranasal sinuses are necessary to make a diagnose. 5 patients suffering from the isolated sphenoid sinus lesion were diagnosed and treated at the Otolaryngology Department of Medical University of Lodz in 2007. Clinical data of these patients were analysed retrospectively. 4 underwent the transnasal endoscopic sphenoidotomy. There were 3 patients with chronic sinusitis, 1 with pyocele. 1 patient didn't agree for the operation. All treated patients noted improvement in the preoperative symptoms. There were no complications during and after the operation. Endoscopic sphenoidotomy is an effective and safe method of treatment of the isolated sphenoid sinus diseases. Nasal endoscopy and CT imaging are necessary for a precise diagnosis and treatment decision.

Headache induced by an arachnoid cyst of the sphenoid sinus: a rare diagnosis problem?

We describe a diagnostic problem in a young adult with a long history of frequently occurring headache episodes. The cause for these episodes was traced to a rare condition, extensive arachnoid cyst of sphenoid sinus. Extensive lesions of the sphenoid sinus are relatively rare and can cause non-specific symptoms. Thus they can represent a major pre-operative diagnosis dilemma even with access to advanced imaging techniques.

Co‐existing fibrous dysplasia and atypical lymphoplasmacyte‐rich meningioma

We report an unusual and extremely rare case of coexisting fibrous dysplasia of the sphenoid sinus with atypical lymphoplasmacyte rich meningioma (World Health Organization Grade II), right frontal lobe in a 25-year-old male. The patient presented with history of generalized tonic clonic seizures with a loss of vision in the right eye. Radiologically it was seen that the sphenoid sinus lesion was sclerotic and was extending and causing compression of the optic nerve. Magnetic resonance imaging revealed mass lesion in the right frontal lobe, iso to hypointense on T, weighted images and hyperintense on T2 weighted images with uniform contrast enhancement. Clinically and radiologically the possibility of fibrous dysplasia of the sphenoid bone and sinus with metastases in the frontal lobe from a different primary was considered. On histopathology the frontal lobe lesion showed a tumor composed of cells with vesicular nuclei, focal nuclear pleomorphism, a mitotic rate of = 4/10 high power field and a single focus of necrosis. The cells were arranged in fascicles and had a prominent lymphoplasmacytic infiltrate. In contrast, the sphenoid sinus lesion was composed of narrow, curved bony trabeculae with a characteristic fishhook configuration without osteoblastic rimming and interspersed with fibrous tissue of variable cellularity. Although no definite causative factors are described for the coexistence of these tumors, however, a common yet undetermined denominator in the origin has been proposed in the literature.