Sphenoid Sinus Lesions Research Articles

Isolated Sphenoid Fungal Sinusitis With Mucocele Mistaken for Chordoma: A Study of Two Unique Cases

Isolated sphenoid fungal sinusitis (ISFS) is a rare condition characterized by fungal infection of the sphenoid sinus. It often presents with non-specific symptoms, which can lead to misdiagnosis. This study presents two unique cases of ISFS with mucocele that were initially misdiagnosed as chordoma based on preoperative radiographic findings. Two cases of ISFS were thoroughly investigated, including clinical examinations, radiological assessments, and surgical explorations. The patients’ symptoms, radiographic findings, surgical procedures, and postoperative outcomes were documented. In both cases, radiographic assessments raised suspicion of chordoma due to bony destruction and soft tissue lesions involving the sphenoid sinus and clivus. However, endoscopic sinus surgery revealed fungal balls and mucoceles, confirming the diagnosis of ISFS. Postoperative pathology confirmed the presence of aspergilloma. The patients recovered well with appropriate treatment. ISFS is challenging to diagnose due to its deep anatomical location and non-specific symptoms. Visual disturbances, particularly affecting the abducens nerve, are common. Sphenoid sinus mucocele, though rare, can be present. Surgical exploration plays a crucial role in establishing an accurate diagnosis and initiating appropriate treatment. ISFS can mimic other skull base lesions, such as chordoma, on preoperative radiography. These cases underscore the value of surgical exploration in reaching an accurate diagnosis and highlight the need for the cautious interpretation of radiological findings in sphenoid sinus lesions to ensure optimal patient care.

An Ecchordosis Physaliphora, a Rare Entity, Involving the Central Nervous System: A Systematic Review of the Literature.

Ecchordosis physaliphora (EP) is a benign notochordal remnant, which is often an incidental finding; however, it can rarely present with neurological symptoms. We performed a systematic review of the literature for cases of symptomatic EP published in PubMed, Web of Science and Embase from January 1982 to May 2023. This is the largest review to date and revealed 60 cases including ours. Headache (55%) and CSF rhinorrhea (32%) were the most frequent clinical manifestations. The majority of symptomatic EP lesions were located in the prepontine region (77%) and required surgical resection (75%). EP should be considered in patients with neurologic symptoms in the setting of prepontine or posterior sphenoid sinus lesions. While symptomatic patients often require surgical intervention, rare cases may respond to oral corticosteroids.

접형동의 함기화 정지 2예 및 문헌고찰

Arrested pneumatization of the sphenoid sinus is normal developmental variant. Radiological find-ing on computed tomography (CT) or magnetic resonance image (MRI) may be confused with bony lesions of paranasal sinuses or invasive tumors of the skull base. A 43-year-old woman visited our hospital with headache, and an MRI scan performed at other hospital showed abnormal findings in the right sphenoid sinus. When the additional CT images were evaluated, it was diagnosed as an arrested pneumatization of the sphenoid sinus. A 46-year-old woman visited the neurologist with diplopia and had a brain MRI. Due to abnormal findings in the left sphenoid sinus, the patient was transferred to the otorhinolaryngology department. The left sphenoid sinus lesion was confirmed as an arrested pneumatization on CT and MRI. Both patients decided to follow-up without any special treatment. Differential diagnoses for this developmental variant would reduce treatment cost and exploratory surgery.

Sphenoid sinus anatomical variants and pathologies: pictorial essay.

The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.

Mononostril Endoscopic Approach for Bilateral Sphenoid Sinus Lesions.

A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with treatment results for patients. We retrospectively analyzed 16 patients who underwent a mononostril endoscopic surgery for bilateral sphenoid lesions from 2018 to 2022. Endoscopic mononostril surgery for bilateral sphenoid lesions was performed for 13 cases under general anesthesia and 3 cases under local anesthesia. The surgical approach to the sphenoid sinus was transnasal approach in 8 cases and transethmoidal in 8 cases. Among those with bilateral sphenoid sinuses lesions, fungal ball and sinusitis were the most common. After surgery, the size of the sphenoid sinus opening remained almost the same in 14 patients. It decreased but maintained in 2 patients. There was no recurrence of sphenoid lesions. The mononostril endoscopic approach for bilateral sphenoid lesions is a feasible, safe, effective, and minimally invasive surgical technique.

Outcomes of trans-nasal trans-sphenoid endoscopic approach in isolated sphenoid sinus and sellar lesions

Outcomes of trans-nasal trans-sphenoid endoscopic approach in isolated sphenoid sinus and sellar lesions

Solitary Sphenoid Sinus Lesion Presenting as Chronic Headache.

Headache is a common symptom with etiologies that are difficult to distinguish, 1 of which is sinusitis. A solitary sphenoid lesion, which is rare, can also cause acute or chronic headaches. The authors investigated whether endoscopic sinus surgery (ESS) for solitary sphenoid lesions could reduce headache symptoms. The authors reviewed the charts of patients who underwent ESS from 2012 to 2017, whose main symptom was a chronic headache for several years. There were no remarkable pathologic findings in the nasal cavity upon endoscopic examination. Medications for reducing headaches had transient effect. Brain magnetic resonance imaging or computed tomography scans showed a solitary sphenoid lesion and the patients underwent ESS by the same otolaryngologist. In total, 16 out of 547 ESS cases that met the above conditions were included in this study. The authors evaluated the duration, character, and degree of the headaches pre- and post-operatively. The authors also determined if there was a correlation between headaches, sphenoidal lesions, and pathologic outcomes. There were significant improvements in headaches after surgery. The pre- and post-operative mean visual analog scale score for headaches was 7.27 ± 1.67 and 3.80 ± 1.82, respectively. The pathologic outcomes revealed chronic inflammation in 11 patients, nasal polyp in 1 patient, inverted papilloma in 1 patient, and fungal infections in 3 patients, but there was no clinical correlation between the headache, lesion site, and pathology. A solitary sphenoid lesion can be the cause of acute or chronic headaches. Headaches from a solitary sphenoid sinus lesion, which were not controlled by medical treatments, could be improved by surgical procedures.

Effect of Fe₃O₄ Nanomaterial-Based MRI on the Efficacy of One-Sided Butterfly Sinus Lesions in the Nose.

Fe₃O₄ materials have many crystal forms, and the morphology of their nanomaterials is more diverse. Under the influence of nano-effects, they exhibit unique physical and chemical properties. The synthesized Fe₃O₄ materials with different morphologies have different properties. They are widely used in related fields such as electromagnetics, chemical engineering, catalysis, sensors, acoustics, medicine, environmental protection and so on. Choosing the appropriate contrast agent to display the anatomical characteristics of diseased and normal tissue is an important thing before using MRI (Magnetic Resonance Imaging) technology. At present, Gd-DTPA is a commonly used magnetic contrast agent in clinical practice, but Gd-DTPA has obvious shortcomings, such as short circulation time, non-specific distribution, and high price. In comparison, the superparamagnetic iron oxide nanocrystals have a high specific distribution in living tissues, mainly concentrated in reticular endothelial cells-rich tissues and organs, such as liver, spleen, lymph nodes and bone marrow. This study analyzed the imaging characteristics of 21 patients with unilateral benign sphenoid sinus disease who were confirmed by nasal endoscopic surgery and postoperative pathology. Among the 21 patients with unilateral benign sphenoid sinus lesions, 7 cases of them had cysts. Those with altered sphenoid sinus cavity expansion may be accompanied by thinning of bone resorption. MRI manifested as long T1 and long T₂ irregular spherical signal shadows. 8 cases of them are fungal lesions. MRI showed mixed signals are in the sphenoid sinus, the flaky exudation showed a high signal, and the fungal nodule showed a low T₂WI signal. In the 3 cases of cerebrospinal fluid rhinorrhea, MRI showed a line between the high-signal shadow of the cerebrospinal fluid and the high-signal liquid shadow in the sinuses. High signal and shadow are connected, and other tissues (brain tissue, nasal mucosa) show low signal. Fe₃O₄-based MRI technology can improve imaging quality and diagnostic efficiency.

A Case of Metastatic Hepatocellular Carcinoma Who Initially Presented with a Sphenoid Sinus Lesion

A Case of Metastatic Hepatocellular Carcinoma Who Initially Presented with a Sphenoid Sinus Lesion

Value of Hounsfield Units in the Evaluation of Isolated Sphenoid Sinus Lesions.

Radiologic findings of fungal sinus disease are generally opacification in paranasal computed tomography (CT) images. The Hounsfield unit (HU) is a standardized objective unit that is also suitable for measuring remodeling and opacifications on CT scans of bone sections of patients with chronic rhinosinusitis. We hypothesized that HU values could provide valuable information in isolated sphenoid sinus lesions before surgery. Between 2012 and 2019, 35 patients underwent functional endoscopic sinus surgery for sphenoid sinus lesions. Tissues obtained from the sphenoid sinus were divided into two groups, fungal and nonfungal, according to the findings of histopathologic examinations. HU values were measured in sphenoid sinus sections on paranasal CT scans of these two groups. Differences in mean and maximum HU values between the two groups were statistically significant (p < .05). The maximum HU values calculated from the sphenoid sinus were 435.08 and 196.23 (p ≤ .05) in the fungal group and nonfungal group, respectively. The mean HU values calculated from the sphenoid sinus were 64.31 and 29 (p ≤ .05) in the fungal and nonfungal groups, respectively. At the maximum cutoff value of 241, the sensitivity and specificity of the HU maximum were 84.6% and 77.3%, respectively. At the mean cutoff value of 41.5, the sensitivity and specificity of the HU mean were 76.9% and 86.4%, respectively. HU is an objective value used in radiographic density measurement. The HU values were higher in fungal lesions than in nonfungal inflammations, and they are useful in preoperative measurement.

Paranasal sinus CT and 3 kinds of nasal endoscopic sphenoid sinus surgical approaches: Retrospective analysis of 128 cases.

Even being equipped with advanced surgical navigation systems, thorough analysis of patient's imaging diagnosis before procedures is still of great necessity for the operators. This study aimed to explore the morphological changes of sphenoid sinus lesions as observed on computed tomography (CT), and further carry out the fenestration of sphenoid sinus under guidance of the CT.A retrospective analysis of the characteristics of CT images was performed. The outcomes of three kinds of nasal endoscopic surgeries on benign lesions of sphenoid sinuses were investigated. For the 128 patients included, nasal-cavity-olfactory cleft pathway was performed in 64 patients, the Messerklinger pathway was adopted in 54 patients, while Wigand pathway was performed in the rest 10 patients.After follow-up visit, the drainage at the fenestration site of sphenoid sinus was found to be smooth, the symptoms were completely controlled, and no severe complication was reported during or after the surgery. No significant difference was observed in the curative effects among the 3 groups.CT of the paranasal sinus can guide the procedures of sphenoid sinus fenestration. No statistically significant differences were exhibited in terms of the amount of bleeding, surgical time and days of hospitalization among the 3 groups.

Tuberculosis of Sphenoid Sinus: Report of Two Cases

AbstractIsolated lesions of the sphenoid sinus are uncommon and difficult to diagnose. In the absence of characteristic clinical findings, the diagnosis of such lesions depends mainly on imaging. However, as radiological appearance cannot provide the clinician with a definite diagnosis, histopathological examination of the specimen is mandatory for the diagnosis. Endoscopic sinus surgery has been an excellent approach for diagnosis as well as treatment of isolated sphenoid sinus lesions. The disease can be effectively treated by antituberculosis treatment. We report two cases of tuberculosis involving the sphenoid sinus only.

Sphenoid Sinus Fungal Ball, a Tertiary Hospital Experience

Objective: To present the different clinical manifestations and diagnostic strategies of isolated sphenoid sinus fungal ball (SSFB), in order to prevent delayed diagnosis and providing early management. Method: This study is a retrospective clinical study, conducted between January 2008 and November 2019. It was done in the ENT department of two institutes: King Fahad specialist Hospital and Qatif Central Hospital, Saudi Arabia. Only patients with sole involvement of fungal ball in the sphenoid sinus were included. Conclusions: The incidence of isolated sphenoid fungal ball is rare. However, it's clinically important because untreated SSFB can cause significant complications. The clinical features of SSFB are ambiguous and nonspecific which make its diagnosis more difficult. Post-nasal discharge and headache refractory to the medical management are the most common symptoms of isolated sphenoid sinus lesion. CT scan is still the cornerstone of radiological diagnosis of SSFB. Endoscopic sphenoidotomy and removal of fungal debris is the standard care of management. Post-operatively, the majority of patient had good results with no complication and recurrence.

Isolated Sphenoid Sinus Lesions

Isolated Sphenoid Sinus Lesions

Изолированные поражения клиновидной пазухи в практике регионального оториноларингологического отделения

Изолированные поражения клиновидной пазухи в практике регионального оториноларингологического отделения

A Case of Isolated Oculomotor Nerve Paralysis Due to Sphenoid Sinus Cyst

Herein, we report a case of isolated oculomotor nerve paralysis caused by a sphenoid sinus cyst. An 80-year-old man presented with right-sided ptosis, diplopia and occipital headache. He had unilateral ptosis and disturbance of the upward, downward and inward ocular movements, however, ophthalmologic examination showed neither visual impairment, nor pupillary dilatation. The symptoms were clearly caused by isolated right oculomotor nerve paralysis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a lateral sphenoid sinus lesion with a smooth margin compressing the right cavernous sinus and shaving down the surface of the clivus. Based on a diagnosis of sphenoid sinus cyst, we performed endoscopic surgery under general anesthesia. The ocular movements became normal approximately 2 months after the operation and the right-sided ptosis disappeared within 6 months of the sugery. Since oculomotor nerve paralysis due to sphenoid sinus cyst is highly amenable to cure by endoscopic surgery, operation should be aggressively pursued for its treatment.

Isolated Sphenoid Sinus Disease- A Unique Case of Sphenoidal Mucocoele

Introduction&#x0D; Isolated Sphenoid Sinusitis and sinus lesions is a rare entity accounting for just 1-3% of all Sinus afflictions. Most have occurred in men between the ages of 30 and 40 years.&#x0D; Case Report&#x0D; A case of right sphenoid sinus mucocele is reported in a male patient aged 68 years, with size of the lesion (35 x 34 mm) detected by CT &amp; MRI scans. The patient presented with a 3 weeks history of unilateral ptosis, diplopia, and photophobia. He also complained of bilateral nasal obstruction, nasal stuffiness, and a mucoid nasal discharge. Endoscopic decompression of the right sphenoid sinus was performed, and approximately 160 ml of thick, sterile mucoid secretion was aspirated. Despite the size of the mucocele, no significant destruction of the sphenoid walls was evident. Postoperatively within 15 days the patient's symptoms improved significantly.&#x0D; Conclusion&#x0D; The Nasal Endoscope has revolutionised sphenoid sinus mucocele treatment. An adequate sphenoidotomy and drainage give excellent results.

Management of sphenoidal sinus lesions by septal-assisted approach: Surgical skills and advantages.

The aim of this study was to develop a less invasive trans-septal approach for the endoscopic management of sphenoid sinus lesions. We performed a septal-assisted surgical procedure for endoscopic sphenoidectomy in 38 patients with isolated or combined sphenoidal sinus lesions, including fungal balls, mucoceles, purulent cystic sphenoidal sinusitis, etc. The posterior portion of the nasal septum became flexible after removal of the vomer and the sphenoidal rostrum. The superior portion of the common meatus was expanded to accommodate the endoscope after the septum was repositioned contra-laterally. The lesions were individually managed through the enlarged ostiums while damage to the mucosa of the front sphenoidal wall was avoided. All the procedures were completed successfully without intraoperative complications, and the bony ostiums were identified easily and enlarged accurately. During the follow-up period of 16 weeks to 2 years, no re-atresia or restenosis was observed. The recurrence rate was 0. No postoperative complications were recorded. All the responses from the patients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal approach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

Onodi cellと視神経管の走行

In 2014, the Onodi cell was defined as the most posterior ethmoid cell which is situated laterally and/or superiorly to the sphenoid cell. It is closely connected to the optic nerve. So, if it is not recognized during endoscopic sinus surgery, it may result in some optic nerve injury or failure to open the sphenoid sinus.The objective of the present study was to determine the prevalence of the Onodi cell and variations of the optic canal. Paranasal thin slice CT scans obtained from 237 patients in Osaka Kouseinenkin Hospital were analyzed. Patients with previous histories of facial trauma, paranasal sinus surgery or nasal cancer were excluded.The prevalence of the Onodi cell was 27.4% (130 sides). The optic canal exposure types were classified into 4 groups: A: posterior ethmoid only; B: Sphenoid sinus only; C: posterior ethmoid and sphenoid sinus; and D: no exposure. Group A comprised 97 sides, group B 300 sides, group C 49 sides, and group D 28 sides. The prevalence of a pneumatized anterior clinoid process was 21.7% (103 sides). There was a significant correlation between the Onodi cell and sphenoid sinus and paranasal sinus lesions in the Chi-square test. Our data should prove useful in endoscopic sinus surgery. We must take care to avoid the optic nerve injury in patients with Onodi cell and a pneumatized anterior clinoid process.

Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience.

To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions. Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted. A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively. Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.