蝶窦及毗邻关系的解剖对蝶窦手术重要性探讨

蝶窦居于颅底，毗邻结构复杂，常用变异。本文报告开展各类型蝶窦手术１２５例，并就蝶窦区域应用解剖对蝶窦手术的重要性，进行研究与探讨。     

蝶窦前壁距离测定

因蝶窦解剖的特殊性，手术有一定难度，准确定位蝶窦前壁是手术成功的关键。本组测量84侧蝶窦前壁至鼻小柱前缘中点的距离(以下简称前壁距离)，并做统计学处理，获得有关蝶窦前壁距离等数据，供蝶窦手术中参考。     

内窥镜下鼻内蝶窦手术

在鼻内窥镜下经鼻内筛窦以及经鼻腔途径进入蝶窦，克服了以往处理蝶窦的复杂手术的弊端。本文总结了经以上二途径处理４３例蝶窦病变的经验，认为此手术进路简便、安全、直视下操作、实用性强，可作为治疗蝶窦疾病的常规手术进路。     

蝶窦病变鼻内窥镜手术

蝶窦病变鼻内窥镜手术田熙王正敏蝶窦解剖部位深在，常规检查不易发现阳性体征，故诊断有一定困难。近年来通过ＣＴ和ＭＲＩ检查发现愈来愈多的蝶窦病变。高分辨鼻内窥镜为治疗蝶窦病变提供了方便，具有避免面部切开，直达病变区处理病灶的优点。我院鼻内窥镜下行蝶窦手术...     

内窥镜下鼻内蝶窦手术

在鼻内窥镜下经鼻内筛窦以及经鼻腔途径进入蝶窦，克服了以往处理蝶窦的复杂手术的弊端。本文总结了经以上二途径处理43例蝶窦病变的经验，认为此手术进路简便、安全、直视下操作、实用性强．可作为治疗蝶窦疾病的常规手术进路。     

复发性垂体瘤再次经鼻中隔蝶窦径路手术

为总结复发性垂体瘤手术方式和效果，报道再次经鼻中隔蝶窦径路切除复发性垂体瘤１５例，术后随访疗效满意。再次手术时鼻中隔粘膜有不同程度粘连，蝶窦腔内有不同程度纤维组织，其与第一次手术时鞍底的重建方式有明显关系，蝶窦腔内充满瘢痕组织者，不易寻找到鞍底，需用金属条摄头颅侧位片确定鞍底。结果表明，尽管手术有一定难度，但再次经鼻中隔蝶窦径路仍然是切除复发性垂体瘤安全有效的方法     

蝶窦气化类型解剖学研究

观察１１０具成人尸头标本蝶窦气化类型及蝶窦同毗邻结构的关系，根据左右两侧蝶窦气化程度是否相同将蝶窦分为二类，发现相同类蝶窦占４１．８％，不同类蝶窦占５８．２％，相同类蝶窦进一步再分为６型，而不同类蝶窦则根据两侧蝶窦气化程度的组合分为１５型。文中分析了此种分型法在蝶窦及蝶鞍区手术时的意义，以及蝶窦的气化类型同毗邻结构间的解剖变异关系。     

鼻内镜下蝶窦开放术治疗真菌性蝶窦炎10例

目的观察鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的疗效。方法回顾性分析鼻内镜下行蝶窦开放术治疗的10例真菌性蝶窦炎患者，总结其临床表现、影像学特征及治疗效果。结果真菌性蝶窦炎以涕中带血、头痛为主要症状表现，鼻窦CT扫描在其诊断中具有重要意义。经鼻内镜下蝶窦开放术治疗后随访1年，10例均未见复发。结论鼻内镜手术具有创伤小、出血少视野清晰、安全等优点，符合功能性手术的理念，是真菌性蝶窦炎的有效治疗方法。     

蝶窦手术致颅脑穿通伤脑脊液鼻漏死亡一例

患者男，49岁，入院前1周因反复头痛，食欲不振，MRI检查发现左侧蝶窦内致密影（图1），提示蝶窦肿瘤，在外院行经鼻中隔入路蝶窦手术，术中发现手术损伤穿通亟底，取大腿皮肤修补。     

经鼻内窥镜垂体腺瘤切除术

目的 探讨鼻内窥镜在垂体瘤手术中的应用价值和适应证。方法开展了２４例经鼻内镜 体腺瘤切除手术。２４例垂体腺回味各２０例为经鼻蝶窦进路，４例为经鼻中隔蝶窦进路。结果 ２０例经鼻蝶窦进路瘤组织得到了完全切除，手术所需时间较经鼻中隔蝶窦进路显微外科手术明显缩短。４例经鼻中隔蝶窦进路中３例瘤组织完全切除，１例非分泌性腺瘤患者因瘤组织侵犯鞍旁及海绵窦，仅行大部分切除。所有秫后能、视力障碍和闭经泌乳等症状均有     

孤立性蝶窦霉菌病

目的：为了提高对蝶窦霉菌病的认识,以利其诊断和治疗。方法：回顾性调查孤立性蝶窦霉菌病16例,总结其临床表现,影像学特征及治疗效果。结果：在1985－1998年间收治孤立性蝶窦霉菌病共16例,多数为中老年女性,最主要的临床症状为回吸涕带血,约上中81％,其次为头痛,占69％,1例患者出现视力下降和复视,蝶窦霉菌病变的影像学表现主要为蝶窦内低密度的组织影伴骨壁增厚和窦内软组织影中有钙化灶,CT检查有利于解病变的范围及性质,全部病例均承鼻内窥镜下行蝶窦手术,手术安全,出血少,并发症少,术后恢复快等特点。结论：蝶窦霉菌病较少见,其头痛,器吸涕中带血等主诉易与其它一些疾病相混淆,临床上应给予高度重视,蝶窦霉菌病可采用鼻内窥镜下蝶窦手术。     

蝶窦炎性病变和肿瘤的诊断与治疗

分析２７例蝶窦炎性病变和肿瘤的临床资料，其中炎症１２例，良性肿瘤１０例，恶性肿瘤５例。比较了蝶窦炎性病变与肿瘤的ＣＴ扫描与ＭＲＩ检查的表现，发现炎性病变骨质侵蚀较肿瘤者少，Ｔ＿２信号强度增强较明显，讨论了各种蝶窦手术进路的适应症，提出经鼻外筛窦进路是治疗蝶窦病变的优选术式。     

蝶窦外侧壁的应用解剖

６３侧尸头解剖测量结果表明，蝶窦外侧壁上颈内动脉骨性隆起可分为①鞍前段，其长度、骨质厚度及至中线距离的均值分别为６．８、１．０、６．２ｍｍ；②鞍下段，其长度、骨质厚度及至中线距离的均值分别为６．６、１．０、５．０ｍｍ；③鞍后段，其长度、骨质厚度及至中线距离的均值分别为６．６、１．８及７．１ｍｍ。视神经管隆起的长度，骨质厚度及至中线距离的均值分别为４．８、１．０、５．５ｍｍ。上颌神经隆起的长度，骨质厚度及至中线距离的均值分别为５．３、１．２、８．５ｍｍ。     

Diagnosis and Management of the Opacified Sphenoid Sinus

The growing number of surgical procedures at the base of the skull makes a clear understanding of sphenoid disease and its anatomic relationships important for the modern otolaryngologist. We present five cases demonstrating the spectrum of sphenoid sinus disease, its systemic as well as local complications, and its surgical management. Pertinent anatomic and embryologic relations are reviewed and their diagnostic evaluation is discussed. Pitfalls in the diagnosis and management of these diseases are reviewed noting possible complications and significant danger points. The necessity for cooperation among the otolaryngologist, neurosurgeon, and ophthalmologist in the management of these entities is also demonstrated.     

Sphenoid sinus mucocele

Sphenoid sinus mucocele is a rare entity that can occur alone or as a result of ethmoid sinusitis and polyposis. A myriad of presentations is possible due to the presence of important contiguous neurologic and vascular structures. Past surgical approaches to the sphenoid sinus have problems associated with them. The endoscopic sinus technique offers outstanding visualization and a safe, straight-forward approach to the sphenoid sinus. Four patients with documented mucocele of the sphenoid sinus were treated successfully with endoscopic sinus surgery. The technique involves partial removal of the inferior middle turbinate and direct entrance into the sphenoid sinus through the anterior sinus wall. Other sinus abnormalities can be treated simultaneously as required. Sphenoid sinus mucocele is discussed from the standpoint of cause, clinical presentation, and treatment options.     

Invasive Fungal Sinusitis of the Sphenoid Sinus

Objective

This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.

Methods

A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted.

Results

Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027).

Conclusion

The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.     

Inverted Papilloma of the Sphenoid Sinus Presenting With Auditory Symptoms: A Report of Two Cases

Objectives The report aims to inform the reader of cases of inverted papilloma involving the sphenoid sinus presenting with auditory symptoms. Study Design Case series. Methods A retrospective medical record analysis was carried out to identify patients with inverted papilloma involving the sphenoid sinus that presented with a primary complaint of hearing loss or tinnitus, or both. Clinical records, including initial history and physical examination, audiologic and radiologic studies, and operative and histopathologic reports, were carefully examined. A complete literature review for relevant studies was performed to explore possible pathophysiologic factors and similar cases. Results Two patients with inverted papilloma presenting with primary auditory complaints were identified. One patient had roaring tinnitus and sensorineural hearing loss demonstrated with audiologic assessment, whereas the other had pulsatile tinnitus. Both patients had biopsy‐proven inverted papilloma involving the sphenoid sinus, and both patients underwent endoscopic resection of the disease. No other cause or origin of their auditory symptoms was confirmed. The auditory symptoms of both patients improved markedly after excision of their inverted papillomas. Conclusions Tinnitus with or without hearing loss is an unusual presentation of inverted papilloma of the sphenoid sinus. Sphenoid tumors should be considered in the workup of these symptoms.     

Sphenoid sinus revisited

J. H. Maxwell, M.D., in 1959 presented a paper on, “The Diagnosis of Chronic Inflammatory Lesions of the Sphenoid Sinus.” In that paper he reviewed chronic inflammatory lesions of the sphenoid sinus and demonstrated through means of case presentations various techniques required for proper diagnosis. During the past five years at the Geisinger Medical Center some interesting noninflammatory lesions of the sphenoid sinuses have been observed and will be reviewed. The symptoms of these sphenoid sinus lesions are usually related to abnormalities of the orbit and/or nasal passages. Cerebrospinal fluid rhinorrhea and meningitis may be present. Pain, when present, is generally not as severe as that described in inflammatory lesions, but is still localized in a similar manner. The diagnosis of sphenoid sinus disease may be suspected on the history and x-rays of the paranasal sinuses. Poytomography and computerized tomography scanning have aided markedly in the identification of the sphenoid lesions. Surgery in these cases included either a transnnsal or sublabial transseptal approach to the sphenoid sinus and is recommended as a method to gain access to this rather obscure area.     

Isolated Sphenoid Sinus Disease: An Analysis of 132 Cases

Solitary involvement of the sphenoid sinus is a relatively uncommon entity. A series of 132 patients with isolated sphenoid disease accumulated over a 22-year period is reported. A retrospective chart review was performed with special attention to the patients' presenting signs, symptoms, and radiographic findings. There were 80 patients with inflammatory disease, 38 with neoplasms, four with fibroosseous disorders, and 10 with traumatic and developmental lesions. The most common presenting symptom was headache, followed by visual changes and cranial nerve palsies. Cranial nerve abnormalities were encountered in 12% of the inflammatory cases, 60% of the benign tumors, and 57% of the malignant tumors. Radiographically, bone remodeling was associated with chronic inflammatory disease, especially mucoceles. Bone erosion was found principally with neoplastic disease, occurring rarely with mucoceles. Extension was associated with malignant tumors.     

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。