Management of Sphenoidal Sinus Lesions by Septal-assisted Approach: Surgical Skills and Advantages

Summary： The aim of this study was to develop a less invasive trans-septal approach for the endo- scopic 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 sep- turn 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 con- tra-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 accu- rately. 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 pa- tients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal ap- proach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

Anatomic Variants of Sphenoid Sinuses and Adjacent Structures: A Study of 225 Skull CT Scans at CNHU-HKM in Benin, West Africa

Objective: This study aimed to describe anatomic variants of sphenoidal sinuses and adjacent structures. Methods: A retrospective and descriptive study was carried out at The National and University Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM), of Cotonou in Benin from November 1st to December 31st. A review of CT scans skull was done for the subjects aged at least 16 years old. Anatomic variants of the sphenoid sinuses and adjacent structures have been investigated. Results: 225 CT scans of skull were analyzed. The sellar type was the most common type of pneumatization of sphenoid sinuses (74.7%). Pneumatization of anterior clinoid processes of greater and lesser wings of the sphenoid and of pterygoid processes was observed in 7.1%;4.6%;3.3% and 7.3%;respectively. Protrusion of carotid canals and optic canals, maxillary and vidian nerves were observed in 48.3%;13.1%;18% and 9.5%;respectively. Conclusion: Risky anatomic variants of the sphenoid sinuses and adjacent structures are also described by CT-scan among Beninese. Before any surgery and to avoid bad outcome, a precise approach of these risky anatomic variants must be carried out by using CT-scan.

Treatment of Organized Hematoma of the Sphenoid Sinus with Pre-Operative Embolization and Endoscopic Resection

The differential diagnosis for expansile masses of the sphenoid sinuses includes both benign and malignant lesions. We herein present a case of a 79-year-old female who presented with chronic epistaxis and an expansile soft tissue mass centered in the sphenoid sinus with erosion of the skull base. Endoscopic resection of the lesion was performed, with histopathological examination revealing organized hematoma. To our knowl- edge, this is the first reported case of sphenoid sinus organizing hematoma treated with pre-operative embolization followed by endoscopic excision.

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

The relationship between the volume of sphenoid sinus (SS) and the prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusions in the SS was studied by using high-resolution CT imaging. The ICA and ON protrusions in SS were observed in randomly selected normal head CT scanning images from 350 adult subjects. Ac-cording to the incidence of ICA protrusion, three groups were divided into no ICA protrusion (70.75%), unilateral protrusion (8.68%) and bi-lateral protrusions (20.57%). The ON protrusion accounted for 16% in 350 subjects and accom-panied absolutely with ICA protrusion, but ICA protrusion appeared without accompanying with ON protrusion. The SS volume depended upon the protrusions in it and showed statistical dif-ferences, without ICA protrusion, the smallest size (11.16 ± 1.60) cm3;the unilateral protrusion, medium size (14.20 ± 1.80) cm3 and the bilateral protrusion, the largest size (25.03 ± 2.21) cm3. By observing 3D reconstructed models of ON and SS, we found ON was adjacent to SS (46%) and to posterior ethmoid sinuses (44%). The current study indicates that SS volume is varied with numbers of the protrusions and that ON location varies with the pneumatization of SS. Our results provide an anatomical basis to the surgeries for SS and its surrounding structures.

Application and Care of Two Kinds of Sphenoid Sinus Packing Materials after Pituitary Tumor Resection with the Transnasal Endoscopic Approach

Background: Neuroendoscopic transsphenoidal approach for resection of pituitary adenomas has the advantages of less damage, fewer complications, and a faster recovery than the traditional approach and has beening favored by neurosurgeons. However, there has no standard method of selecting suitable packing materials after the operation to relieve pain in patients and achieve the ideal hemostatic effect. We compared the postoperative complications and treatment effects of two different packing materials in patients with pituitary adenomas. Objective: To investigate the advantages and disadvantages of using a catheter balloon and iodoform gauze for hemostasis in patients undergoing pituitary tumor resection by neuroendoscopic transsphenoidal approach. Materials and Methods: We retrospectively analyzed these data of 48 cases treated with pituitary adenoma resection by the single nasal approach from January 2018 to October 2019 in Sun Yat-sen University Cancer Center. According to the type of sphenoid sinus packing material used, these patients were divided into balloon tamponade oppression group (24 cases) and tela iodoformum oppression group (24 cases), respectively. The balloon tamponade oppression group received catheter balloon tamponade oppression hemostasis, and the tela iodoformum oppression group underwent tela iodoformum oppression hemostasis. The outcomes and complications were compared between the two groups in which two kinds of sphenoid sinus packing materials were used for hemostasis after tumor resection by transnasal endoscopic approach. For the catheter balloon compression hemostasis method, on account of the plasticity of the balloon, the volume of water in the balloon can be adjusted according to the size of the patient’s own sphenoid cavity. The amount of bleeding and several complications in terms of discomfort during placement and removal of the packing material, rebleeding after removal of the packing, cerebrospinal fluid rhinorrhea and electrolyte disturbance are compared between the two groups. Results: 48 patients were enrolled. The two groups’ data of patients were similar in age structure, sex ratio, tumor size at baseline and so on. No complications, such as abscess formation, were found in both groups. The success rate in the compression with catheter balloon group was 100% (24 of 24 patients);and in the iodoform gauze group 83.33% (20 of 24 patients). A catheter balloon was more successful in stopping bleeding at early stage than iodoform gauze. There were no statistically significant differences in the hospitalization stay time, operating day to discharge day and tampon indwelling time (P > 0.05). There were also no significant differences in pairwise comparison between the catheter balloon group and iodoform gauze groups in the incidence of cerebrospinal fluid rhinorrhea or electrolyte disturbance between the two groups (P > 0.05). The incidence of headache in the catheter balloon group was statistically significantly lower than that in the iodoform gauze group (P < 0.05). Conclusion: In patients undergoing endoscopic pituitary tumor resection, compression and hemostasis by means of catheterization expansion lead to lower rates of injury and complications and have a good effect, so this method is worthy of being recommended for clinical practice.

Solitary Fungus Ball of the Sphenoid Sinus

A 50-year-old woman with long standing nonspecific disturbing headaches of the mid-face and rear of the head plus retro-orbital pain for about one year duration was proved to suffer from the fungus ball involvement of the left sphenoid sinus after operation. The diagnosis was established by histopathologic examination of the specimen removed at the time of operation.

经鼻内镜手术治疗以眼部症状为首发的真菌性蝶窦炎

目的探讨以眼部症状为首发的真菌性蝶窦炎的早期诊断及导航辅助下真菌病变清除术。方法对2007年1月-2022年12月广州市中山大学附属第一医院耳鼻咽喉科收治的17例以眼部症状为首发的真菌性蝶窦炎患者的临床表现、影像学检查、手术方法及术后转归等方面进行回顾性分析,总结临床经验。结果17例患者影像学均符合真菌性鼻窦炎,且术后病理确诊为真菌感染。11例患者术后眼部症状得到不同程度改善,包括视力下降、眼球运动障碍、眼睑下垂等,6例患者术后症状无明显改善。结论临床上病因不明的渐进性视力下降及迁延不愈的头痛,应考虑真菌性蝶窦炎可能,及时完善头颅CT、MRI等检查,一经确诊首选鼻内镜下手术治疗。术中导航技术可辅助准确定位病变并判断病变范围,保障手术安全并提高手术效率。侵袭性真菌性鼻窦炎需要联合系统性抗真菌治疗。

真菌球型蝶窦炎和真菌球型上颌窦炎的临床症状及影像学特征比较

目的分析真菌球型蝶窦炎和真菌球型上颌窦炎的临床症状及影像学特征。方法收集2015年1月至2020年6月就诊于我院的30例真菌球型蝶窦炎患者以及同期收治的126例真菌球型上颌窦炎患者的病历及影像学资料,对比分析两者的临床症状及影像学特征。结果真菌球型蝶窦炎和真菌球型上颌窦炎均好发于40~60岁的女性,病程均以半年内最常见,CT特征性表现均为钙化灶及骨质增生。与真菌球型上颌窦炎相比,真菌球型蝶窦炎的头痛、眼胀、溢泪更多见(P<0.05);与真菌球型蝶窦炎相比,真菌球型上颌窦炎的面部不适更多见(P<0.05)。结论真菌球型蝶窦炎和真菌球型上颌窦炎的CT特征均为钙化灶、骨质增生。头痛是真菌球型蝶窦炎常见且相对特征性的临床症状。眼胀和溢泪是真菌球型蝶窦炎相对特征性的临床症状,面部不适是真菌球型上颌窦炎相对特征性的临床症状。

Ocular cranial nerve palsies secondary to sphenoid sinusitis

Objective:The clinical presentation of sphenoid sinusitis can be highly variable.Rarely,sphenoid sinusitis may present with cranial nerve complications due to the proximity of these structures to the sphenoid sinus.Method:A case series from Rabin Medical Center and all cases of cranial nerves palsies secondary to sphenoid sinusitis that have been reported in the literature were reviewed.Results:Seventeen patients were identified.The abducent nerve was the most common cranial nerve affected (76％),followed by the oculomotor nerve (18％).One patient had combined oculomotor,trochlear and abducent palsies.The most common pathology was isolated purulent sphenoid sinusitis in 64％ followed by allergic fungal sinusitis (AFS) in 18％,and fungal infection in 18％.94％ had an acute presentation.The majority (85％) received a combined intravenous antibiotics and surgical treatment.The remainder received conservative treatment alone.Complete recovery of cranial nerve palsy was noted in 82％ during follow up.Conclusion:Sphenoid sinusitis presenting as diplopia and headaches is rare.A neoplastic process must be ruled out and early surgical intervention with intravenous antimicrobial therapy carry an excellent outcome with complete resolution of symptoms.

Kartagener综合征鼻窦炎的治疗——附1例报道及文献复习

目的 探讨Kartagener综合征鼻窦炎的有效治疗措施。 方法 回顾诊治的 1例Kartagener综合征鼻窦炎病人并结合文献复习 ,分析Kartagener综合征及其鼻窦炎的病因、诊断和治疗方法。 结果 Kartagener综合征病人因基因突变致纤毛结构和功能异常 ,从而出现慢性鼻窦炎、支气管扩张、内脏反位三联症 ,针对其鼻窦炎的有效治疗可能可以减轻支气管、肺疾病的发展。结论 鼻窦炎常为Kartagener综合征首发症状 ,及早确诊并选择最合适的治疗方式 ,有益于疾病的转归。

以神经系统表现为首发症状的孤立性蝶窦炎诊治分析

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。

蝶窦黏液囊肿的临床表现与影像学诊断

蝶窦黏液囊肿少见,仅占鼻窦黏液囊肿的1%。本文总结了自1999年1月～2007年5月本院收治的蝶窦黏液囊肿患者17例,报道如下。1

霉菌性鼻窦炎临床诊治分析

目的探讨霉菌性鼻窦炎的诊断分型和治疗方法。方法回顾性分析21例霉菌性鼻窦炎病人临床资料,全组病例均行手术治疗,其中功能性鼻窦内镜手术(FESS)13例、柯陆氏5例、鼻内镜下单纯蝶窦开放术1例、FESS加蝶窦开放术2例。结果21例病人均治愈,且均经术后病理证实。结论霉菌性鼻窦炎以上颌窦多发,蝶窦、筛窦次之、额窦最少,分型以非侵袭性霉菌性鼻窦炎最常见,CT检查是早期诊断的有效途径。疗效预后关键在于鼻窦开放程度、引流通畅与否。

慢性蝶窦炎

蝶窦炎因其特殊的解剖部位及无独特临床症状，往往被临床医师忽视，以往报道少。本组分析了５８例蝶窦炎，其特异的临床症状不明显，由于ＣＴ、ＭＲＩ和鼻内窥镜的广泛应用，使本病诊断已不困难。鼻内窥镜下的手术处理，患者痛苦少，操作简单。本组大部分病例（５３例）为继发于鼻腔及筛窦病变的蝶筛窦炎，孤立性蝶窦炎５例，在临床上比较少见。

真菌球型蝶窦炎临床分析

目的提高对孤立性真菌球型蝶窦炎的认识,有利于早期诊断和治疗。方法回顾性分析10例孤立性真菌球型蝶窦炎的临床表现、影像学特点、鼻内镜手术方法及疗效。结果10例患者最主要的临床表现为头痛或/和涕中带血,主要影像学特征为单侧蝶窦内软组织影,骨壁増厚,中央常可见高密度钙化斑。全部患者鼻内镜下行蝶窦开放术,定期换药,随访3～18个月,全部治愈。结论孤立性真菌球型蝶窦炎临床表现无特异性,早期不易发现,CT扫描及鼻内镜检查有利于早期诊断,病理学检查可确诊,采用鼻内镜下蝶窦开放术具有创伤小、并发症少和术后恢复快等优点,值得推广。

双侧扩大蝶窦成形术治疗难治性蝶窦炎的临床分析

目的探讨双侧扩大蝶窦成形术治疗难治性蝶窦炎的手术适应证、手术方法及术后疗效。方法对收治的难治性蝶窦炎采用双侧扩大蝶窦成形术,术后随访观察患者的临床疗效。结果 6例诊治的难治性蝶窦炎患者术后头痛、头闷胀感等临床就诊症状均明显缓解,未发生动脉性鼻出血及鼻中隔穿孔等并发症,术后所有患者术腔黏膜均上皮化良好,黏膜完全上皮化时间平均8.4周。结论采用双侧扩大蝶窦成形术治疗难治性蝶窦炎,效果良好,是一种值得推广的手术方法。

孤立性蝶窦病变临床分析

孤立性蝶窦病变早期症状无特异性，随着病变的发展，可导致海绵窦综合征和（或）眶尖综合征，从而引起严重并发症，如失明、脑疝等，早期诊断和及时治疗尤为重要。近10年来由于CT、MRI及鼻内镜技术的发展和广泛应用，

HRCT与鼻内镜对鼻窦炎鼻息肉相关异常诊断的比较

目的对照鼻窦炎鼻息肉的冠状位HRCT表现与FESS术中内镜所见,比较两种方法对鼻腔内间隙、窦口等异常的精确诊断能力。方法详细记录102例(202侧)鼻窦炎鼻息肉冠状位HRCT表现与FESS手术中所见。结果①对鼻腔内间隙和上颌窦口狭窄的检出,CT优于内镜;对前筛口、后筛口和蝶窦口的显示,内镜优于CT。②中鼻道息肉和鼻中隔偏曲的诊断率,内镜高于CT。③上颌窦内异常,如黏稠脓液、黏膜增厚、息肉、黏膜囊肿等,CT表现有一定特点。结论冠状位HRCT和内镜对鼻窦炎鼻息肉相关异常的精确诊断各有优势,应该互相补充、印证,不可以相互替代。

经鼻内镜颅底手术后蝶窦炎的诊断与治疗

目的回顾分析经鼻内镜颅底手术后蝶窦炎的致病原因,总结其诊断与治疗特点并评价预后。方法纳入2005年6月至2017年12月行经鼻内镜颅底手术后继发蝶窦炎的患者共24例,采用扩大内镜经鼻入路手术开放蝶窦并清除病灶;通过鼻窦CT、MRI、鼻内镜检查,以及视觉模拟评分(VAS)和Lund-Kcnncdy评分评价患者预后。结果临床表现以头痛(21例,87.50%)、鼻塞(11例,45.83%)、流涕(9例,37.50%)为主要症状。术前鼻窦影像学检查可见广泛性蝶窦壁骨质增厚和(或)蝶鞍骨质不连续,蝶窦壁黏膜呈中等强化征象;术中鼻内镜下可见后组筛窦和蝶窦区黏膜水肿、息肉、瘢痕形成。手术前后VAS评分之头痛(F=118.961,P=0.000)、鼻塞(F=3.519,P=0.035)、流涕(F=30.563,P=0.000)和Lund-Kennedy评分(F=26.064,P=0.000)差异具有统计学意义,其中术后3和12个月V AS评分之头痛(均P=0.000)、流涕(均P=0.000)和Lund-Kennedy评分(均P=0.000)均低于术前。结论经鼻内镜颅底手术视野不充分,不恰当应用人工材料可导致蝶窦炎症反应,引起较严重的头痛、鼻塞和流涕症状;以内镜下扩大开放蝶窦,清理窦内病变组织和修复材料为首选治疗方法,从而改善症状和使黏膜上皮化。

孤立性真菌球型蝶窦炎13例临床分析

目的:探讨孤立性真菌球型蝶窦炎的临床特征及鼻内镜手术疗效。方法:回顾性分析13例确诊为孤立性真菌球型蝶窦炎患者的临床症状、鼻内镜检查所见、影像学特点、鼻内镜手术疗效。结果:临床症状为头痛10例次(77%),涕中带血2例次(15%)。鼻内镜检查发现蝶窦自然口周黏膜息肉样变6例,蝶窦自然口闭锁1例。鼻窦CT扫描显示全部病例单侧蝶窦腔内混浊影,其中有高密度的钙化斑块或斑点9例,窦腔骨壁增厚6例,蝶窦前壁破坏2例,窦腔内有气泡样影2例。全部患者采用经蝶窦自然口径路鼻内镜下蝶窦开放术,术后随访1～4年,临床症状消失,术腔清洁,无一例复发。结论:孤立性真菌球型蝶窦炎临床症状无特异性,以头痛最为常见;鼻窦CT扫描显示蝶窦腔内混浊影伴有斑点状或条块状钙化是本病最具特征性的表现;鼻内镜结合鼻窦CT检查可提高本病的诊断率;鼻内镜下经蝶窦自然口径路蝶窦开放术是治疗本病的首选方法。