孤立性蝶窦疾病

Isolated sphenoid sinus diseases

目的探讨孤立性蝶窦疾病的临床表现特点,为临床诊断和鉴别诊断提供参考。方法分析18例孤立性蝶窦疾病临床症状、体征、影像学资料、诊断和治疗结果。结果18例中主诉头痛16例,8例视力下降和/或复视4例、眼球胀痛2例、眼球突出及眼球固定1例,涕中带血2例、脓涕1例。检查8例有Ⅱ或Ⅵ颅神经损伤,其中1例Ⅱ、Ⅲ、Ⅳ、Ⅵ颅神经均受损。所有病例鼻科检查中只有4例鼻腔所见能够提示后组鼻窦病变。15例为孤立性蝶窦炎症性病变(10例孤立性蝶窦炎,3例蝶窦黏液囊肿,2例霉菌性蝶窦炎),蝶窦脑脊液鼻漏、蝶窦骨瘤和蝶窦腺样囊性癌各1例。结论孤立性蝶窦疾病是一直存在而未被充分认识的一组疾病。它可仅以头痛或视力下降、复视等为主要临床表现,而鼻部表现不显著。因此,在头痛或视力下降的诊断和鉴别诊断中孤立性蝶窦疾病是不可忽略的因素。CT和MRI是孤立性蝶窦疾病的重要诊断手段。

OBJECTIVE To review the clinicalmanifestations of isolat ed sphenoid sinusdiseases. METHODS The symptoms,signs,imaging data,diagnoses and outcomes of 18 cases with isolated sphenoid sinus diseases hospitalized were analyzed retrospectively.in the Second Affiliated Hospitaof Fujian Medical University from Jan. 1995 to Dec. 2003RESULTS The chief complaints of the patients includedheadache(16 cases),hypopsia and / or diplopia(8cases),ache of eyeball(2 cases),blood in nasadischarge(2 cases),exophthalmus and fixation oeyebal l(1 case),purulent nasal dischar ge(1case). The Ⅱ or Ⅵ cranial nerves were involved in 8cases. The Ⅱ,Ⅲ,Ⅳ and Ⅵ cranial nerves were in-volved in 1 of those 8 cases. Only 4 patients showedsigns of posterior sinusitis in rhinologic examinationCT and / or MRI revealed 10 cases with isolatedsphenoiditis. There were 3 cases with sphenoid sinumucocele, 2 cases with fungal sphenoiditis,1 case withnasal cerebrospinal fluid leakage, 1 case with adenoidcystic carcinoma of the sphenoid sinus,1 case withsphenoid sinus osteoma. CONCLUSION Non-nasamanifestations(e.g. headache or hypopsia)can bethe first or unique symptom of the isolated sphenoiddiseases. Isolated sphenoid diseases should be considered in diagnosis and differential diagnosis of headache or visual loss. Usually, no evident nasal manifestations presented. CT and MRI are the best tools indiagnosis of isolated sphenoid diseases.