以神经系统表现为首发症状的孤立性蝶窦炎诊治分析

Clinical analysis of isolated sphenoiditis with initial neurological symptoms

目的探讨以神经系统表现为首发症状的孤立性蝶窦炎的临床特征和治疗方法。方法回顾性分析1998年4月～2004年4月在本院接受治疗的以神经系统表现为首发症状的孤立性蝶窦炎21例的临床表现、影像学资料及诊治经过。结果21例中主诉单纯头痛9例,视力下降和/或复视6例,头痛并有眼部表现者5例,眼球突出者1例。10例有明确的脑神经损害定位症状,包括第Ⅱ对脑神经损害4例,第Ⅲ对脑神经损害1例,第Ⅳ对脑神经损害1例,第Ⅱ、Ⅲ、Ⅳ对脑神经联合损害者2例,第Ⅵ对脑神经损害2例。全部病例均行鼻内镜下蝶窦开放病变清除术,除1例死于颅内感染外,其余病例症状全部缓解。结论以神经系统表现为首发症状的孤立性蝶窦炎尚未被临床各科室充分认识,常在眼科和神经内科误诊误治,因此,在头痛和/或有眼部神经损害病人中应注意孤立性蝶窦炎的鉴别诊断,CT和MRI是其最佳确诊手段,经鼻内镜手术是治疗孤立性蝶窦炎的有效方法。

Objective To analyze the diagnosis and the treatment of isolated sphenoiditis with the initial symptom of neurological manifestations. Methods The data of 21 patients with the initial symptom of neurological manifestations caused by isolated sphenoiditis from April 1998 to April 2004 were retrospectively analyzed. Results The chief complaints of the group included headache （9 cases）, visual loss and/or diplopia （6 cases）, headache and the neuroophthalmologic syndromes （5 cases）, exophthalmos （1 case）. 10 cases presented with precise deficits of the Ⅱ （4 cases）, Ⅲ （1 case）, Ⅴ（1 case）, Ⅱ-Ⅲ-Ⅳ（2 cases）, and Ⅵ （2 cases） cranial nerves. All of the patients underwent endoscopic sphenoidotomy. Only one patient died because of intracranial infection and the others were free of headache after the surgery. Conclusion Isolated sphenoiditis with the presenting symptoms of neurological manifestation should be realized by all of the clinical doctors and should be considered in the diagnosis and differential diagnosis of headache. CT and MRI are the best tools in diagnosis of the isolated sphenoiditis. The results suggest that endoscopic sphenoidotomy is a safe and effective method in the treatment of iolated sphenoiditis.