以眶尖综合征为主要表现的蝶窦病变

目的探讨表现为眶尖综合征的蝶窦病变的诊断与治疗，以降低其误诊、漏诊的发生率。方法回顾2000-2004年12例以眶尖综合征为主要表现的蝶窦病变的病例，分析其临床诊疗过程及误诊原因。结果12例患者主要以眶尖综合征为表现，8例首诊于眼科，2例首诊于心内科（有高血压病史）后转入眼科，2例首诊于神经内科后转入眼科。12例均按眼部病变致眶尖综合征给以治疗，疗效均不明显，最后转入耳鼻咽喉头颈外科。全部病例均经CT或MRI确诊。12例中蝶窦炎性病变7例（包括3例真菌性鼻窦炎）、蝶窦息肉3例、蝶窦脓囊肿2例。全部病例均行鼻内镜下蝶窦开放术，术后所有症状先后缓解甚至消失。结论以眶尖综合征为主要表现的蝶窦病变临床上少见．容易被误诊为眼部疾患，临床医师尤其是眼科医师对该病认识不足易致误诊、漏诊。CT或MRI检查是确诊的标准。鼻内镜技术改进使蝶窦疾病的治疗更安全、更有效。     

孤立性蝶窦疾病18例临床分析

目的：探讨孤立性蝶窦疾病的诊断及合理的治疗方法。方法：回顾性分析18例经鼻内镜手术治疗的孤立性蝶窦疾病患者的临床资料。结果：18例中，炎性疾病l5例(急性炎症2例，慢性炎症3例，囊肿8例，真菌病2例)，恶性肿瘤3例。经鼻内镜手术后随访3个月至半年，蝶窦前壁开窗通畅，窦腔各壁光滑，症状明显改善，无并发症发生。结论：头痛是孤立性蝶窦疾病的常见症状，另有视力损害、血性涕及其他脑神经麻痹症状，CT、MRI及鼻内镜检查为其诊断提供有力依据；鼻内镜手术治疗是一种安全、有效、简便的方法。     

Isolated sphenoid sinus pathology: spectrum of diagnostic and treatment modalities

Objective

Isolated sphenoid sinus pathology is a relatively uncommon entity. The present study is a retrospective review of 40 patients with isolated sphenoid sinus pathology who were treated at the Department of Otorhinolaryngology, Alexandria University between July 2002 and December 2005. Special emphasis will be given to the role of various endoscopic approaches in the surgical management of isolated sphenoid sinus pathology. Factors that govern the selection of each approach will be discussed.

Methods

Extracted data included patient demographics, clinical presentation, imaging studies, treatment modalities and complications. Sphenoid sinus was approached through one of the following three approaches: (1) endoscopic transnasal approach, (2) endoscopic transseptal approach and (3) endoscopic transpterygoid approach. Outcome measures were based on assessment of patients’ symptoms and confirmation of a patent sphenoid sinus by office endoscopy.

Results

The pathology spectrum was rather wide and included 26 (65%) inflammatory conditions (acute/chronic sphenoiditis, mucoceles, and fungal sinusitis), 7 (17.5%) neoplasms and 7 (17.5%) miscellaneous conditions (cerebrospinal fluid (CSF) rhinorrhea, sphenochoanal polyp, and fibrous dysplasia). The most common initial symptom was headache (50%) followed by ophthalmological symptoms (22.5%). Other presenting symptoms included CSF leak in five patients, epistaxis in four patients and nasal obstruction and/or rhinorrhea in two patients. Radiological workup included computed tomography (CT) scan of the paranasal sinuses in all patients. Magnetic resonance imaging (MRI) was performed in 21 patients (52.5%). The most common indication was a sphenoid mass based on endoscopic and CT findings. Four patients with acute/chronic sphenoiditis were successfully treated with medical therapy. One patient with fibrous dysplasia did not require any definitive treatment. Thirty-five patients underwent endoscopic surgery under general anaesthesia. An adjuvant radiotherapy with or without chemotherapy was utilized in two patients.

Conclusions

A high index of clinical suspicion, routine office nasal endoscopy and radiological imaging are central to making an accurate and timely diagnosis of isolated sphenoid sinus pathology. Surgical treatment of sphenoid pathology can be safely and successfully performed through a variety of endoscopic approaches. Selection of the most appropriate endoscopic approach is governed by the nature and location of sphenoid pathology as well as the anatomical configuration of the sphenoid sinus.     

鼻内窥镜下蝶筛区域手术51例临床分析

目的:探讨蝶筛区域病变的特点,提高对本病的诊断及治疗水平。方法:经鼻内窥镜行蝶筛区域手术51例,41例蝶筛窦同时受累者采用经筛窦进路,10例孤立性蝶窦病变采用经鼻腔进路。结果:均无大量出血及其它严重并发症。随访6～36个月,48例痊愈,3例复发,经再次手术后痊愈。结论:蝶筛区域位置隐蔽,早期无特征性症状,易被临床医师忽视。CT检查对本病有较大价值,且对手术具有指导作用;经鼻内窥镜对蝶筛区域病变进行手术治疗,具有创伤少,痛苦小,面部不遗留瘢痕的优点。     

经鼻内窥镜治疗真菌性蝶窦炎

目的探讨经鼻内窥镜治疗真菌性蝶窦炎的手术方法。方法9例真菌性蝶窦炎患者,均采用鼻窦内窥镜手术治疗。结果经6～36个月随访,9例均治愈。结论经鼻内窥镜手术治疗真菌性蝶窦炎具有手术进路安全,患者痛苦小,疗效肯定,术后不易复发等优点。     

鼻内镜下鼻内结构重建治疗鼻源性头痛

目的 探讨鼻内结构重建手术治疗鼻源性头痛的疗效。方法 对50例鼻源性头痛患者实施鼻内镜下矫正鼻内解剖异常,去除鼻腔、鼻窦内病变组织,开放病变窦口,使鼻中隔居中,维持中下鼻甲的形态,消退鼻窦炎症。结果 术后随访3 ~18个月,治愈30例,占60%; 显效12例,占24%; 有效5例,占10%,临床总有效率94%, 无效3例。结论 鼻内镜下鼻内结构重建手术视野清楚,能够准确彻底地清除病灶,使鼻内结构恢复正常,治疗效果良好,具有重要的临床价值。     

伴有颅眶并发症的蝶窦病变35例分析

目的：探讨蝶窦病变伴颅、眶并发症的临床表现及鼻内镜治疗的方法。方法：回顾分析近5年收治的蝶窦病变伴有颅、眶并发症35例患者的临床表现、诊断及手术治疗结果。结果：35例患者中并发脑膜炎5例,海绵窦血栓3例,垂体脓肿2例,颅内多发脓肿1例,球后视神经炎15例,外展神经麻痹8例,眶尖综合征2例（同时并发脑膜炎1例）;所有患者均行鼻内镜下蝶窦开放病变切除术,除1例颅内广泛感染（脑干衰竭）、2例恶性肿瘤患者死亡外,其余症状均不同程度得到缓解。结论：蝶窦病变若不及时治疗,易引起颅、眶并发症,并可导致严重后果。     

内窥镜蝶窦手术的麻醉改进和眼部并发症的预防

目的 :探讨鼻内窥镜手术治疗蝶窦病变的麻醉方法和预防眼部并发症的措施。方法 :在 6 5例蝶窦病变的手术治疗中均行局麻加经改进后的表麻 ;术中彻底止血 ,明确碟窦的位置、窦壁吸收与破坏情况 ,以及病变的部位、色泽和形状等特点 ,密切注意眼部症状 ,避免损伤视神经。结果 :随访 0 .5～ 2年。治愈 5 3例 ,复发 7例(其中内翻乳头状瘤 2例 ,慢性蝶窦炎并息肉 5例 ) ,5例失访 ,仅 5例发生眼部并发症。复发病例经再次手术而切除。结论 :在局麻加改进的表麻下能完成蝶窦内窥镜手术 ,熟悉解剖结构及熟练的手术技巧可减少眼部并发症的发生。     

Endoscopic endonasal transseptal approach for localized sphenoid sinus diseases

Objective

Surgery for localized sphenoid sinus disease can be performed in different ways. Direct (transnasal) and indirect (transethmoidal) approaches are now prevalent in endoscopic endonasal sinus surgery (ESS) because they are safe and effective. However, the identification or treatment of a sinus is occasionally difficult due to the anatomical variation, postoperative changes, or other reasons. In such difficult cases, we currently used an endoscopic endonasal transseptal approach (EETA) to the sphenoid sinus. The indications, procedures, and outcomes of this surgical method are presented here.

Patients and methods

Six of 11 patients with localized sphenoid sinus disease (mycetoma, n = 1; mucocele, n = 5) were treated using EETA. Surgery was performed under local anesthesia in all subjects. Following endoscopic conventional septoplasty, the sphenoid sinus was opened by perforating the anterior wall through the septoplasty wound. The sphenoid disease was treated through this opening, and then drained to the nasal cavity.

Results

The patients operated on using EETA had no surgical complications or disease recurrence, and the use of navigation or fluoroscopy systems was not required. The mean follow-up period of the patients was 27.7 months (range 18–48 months). Follow-up management included endoscopic examination and computed tomography.

Conclusions

A transseptal approach to the sphenoid sinus with a sublabial incision was once frequently performed in pituitary surgery. We modified the transseptal approach as EETA with the use of an endoscope and endonasal incision. This approach is practical and reliable for ESS, and may serve as an alternative for difficult-to-manage sphenoid sinus disease. EETA can be performed in the office as it can be achieved under local anesthesia without a navigation system.     

Internal carotid artery injury during functional endoscopic sinus surgery and its management

Rupture of the internal carotid artery (ICA) during functional endoscopic sinus surgery (FESS) is a rare complication, which can potentially result in death. Only a few cases have been reported in the literature thus far. We present four cases with an ICA bleeding during sphenoidotomy. The treatment is discussed and an emergency plan to manage the heavy arterial bleeding is presented.     

鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿

目的:探讨鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿的治疗方法。方法:在全身应用头孢他啶及万古霉素24 h后,全身麻醉下行病侧上颌窦、筛窦开放术,同时取鼻窦内脓性分泌物做细菌培养及药物敏感试验;对影响鼻窦引流或术后鼻腔清理的鼻中隔偏曲、肥大中鼻甲同期或择期进行处理;术后24 h取出鼻腔填塞物,吸引器每日2次清理术腔渗出物,直至有新鲜肉芽组织完全覆盖创面;对于有细菌培养结果及药物敏感性者,更换抗生素,对于无结果者,继续应用头孢他啶及万古霉素5 d。结果:全部患者未出现眶部、鼻腔、颅内及全身并发症,术后24~48 h体温恢复正常,眼痛、眼胀、头痛症状明显改善,睑、球结膜水肿消腿明显,眼球活动度明显增加;术后13~22 d,全部患者眼部体征恢复正常,随访6个月无复发,6例遗有间断性眼部胀痛感。结论:鼻内镜下眶壁部分切除治疗急性鼻源性眶骨膜下脓肿是安全性高、疗效显著,具有明显优点的治疗方式。     

Clinical characteristics and outcome in patients with isolated sphenoid sinus aspergilloma

Objective

Isolated sphenoid sinus aspergilloma (ISSA) is a rare disorder that is difficult to diagnose in a timely manner. These lesions can also extend to adjacent structures and thereby cause severe complications. ISSA patients with orbital complications typically have a poor prognosis even when surgical interventions have been successful. We here reviewed 30 ISSA cases with respect to clinical characteristics and treatment outcomes.

Methods

A group of 30 patients diagnosed with ISSA between January 1990 and October 2010 were retrospectively reviewed in terms of clinical manifestations, endoscopic findings, radiologic imaging data, and treatment results. We also compared the clinical manifestations and treatment results between patients with and without orbital complications.

Results

Old age (median, 55 years) and a female predominance (23 women in the study) were noted. The most commonly reported symptom was headache (80%) and the average duration of the symptoms before diagnosis was 8.1 months. On radiologic examination, including CT and MRI scans, 13 patients showed bony wall erosions and five patients demonstrated orbital complications including diplopia and visual loss. The appearance of a bony wall erosion on a CT scan and the acute onset of ISSA symptoms were found to be significant factors in the onset of orbital complications (P = 0.003 in each case). Endoscopic sphenoidotomy was performed in all 30 cases. Most of the preoperative symptoms among the patients, including headache, facial pain, and postnasal drip, were improved after surgery. Among the five patients in the study group with orbital complications, diplopia was completely resolved after surgery in each case but there was no improvement in visual loss.

Conclusions

An early diagnosis of ISSA, although not easy, is important to prevent complications arising from extensions of these lesions beyond the sphenoid sinus. Our present study demonstrates that ISSA could be effectively treated with an endoscopic sphenoidotomy, and that timely intervention is needed in patients with a sinus bony wall to prevent irreversible complications such as visual loss.     

Variations of the ethmoid labyrinth and sphenoid sinus and CT imaging

Summary Three hundred macerated and partly isolated postmortem mid-facial bones were studied for the development, variations and dimensions of the structures of the nasal cavity. On 184 axial CT scans of bones (102 male, 82 female) from patients ranging in age from 1 to 90 years old, the dimensions of the ethmoid labyrinth and sphenoid sinus were studied in detail in order to determine which anatomic situation might be unsafe during clinical endoscopic interventions. Six anatomic variations were identified. Most unsafe for surgery seemed to be the following types: type 111, in which the anterior diameter of the ethmoid labyrinth was large and the posterior ethmoid and sphenoid diameters were relatively narrow; type V, in which both ethmoid dimensions were large and the sphenoid diameter was narrow: type VI, in which the ethmoid labyrinth had an hour-glass shape. Present findings indicate that CT orientation before any endoscopic intervention might help to avoid serious complications.     

孤立性蝶窦炎性疾病的诊治

目的 :提高对孤立性蝶窦炎性疾病症状、体征的认识和首诊准确率。方法 :分析 4 9例孤立性蝶窦炎性疾病的临床表现 ,比较非内窥镜手术 10例和内窥镜手术 39例的手术效果。结果 :未经鼻窦内窥镜手术者 ,1例行蝶窦灌洗后头痛立即缓解 ,4例症状在 1周内缓解 ,5例 2～ 4个月后症状复发 ,窦口瘢痕狭窄阻塞 ,需手术切开引流。经鼻窦内窥镜蝶窦开放术者 ,治愈 31例 ,其中 10例手术后症状立即消失 ,2 1例术后 3～ 5d症状缓解 ;好转 8例 ,其中 5例仅感轻微头痛和嗅觉失灵 ,鼻内窥镜见窦口粘膜肿胀 ,CT、MRI复查未见窦腔病变 ;3例术后2个月视力恢复。术后 1个月复诊窦口开放率为 87.2 %。随访 6～ 4 8个月无病变及症状复发 ,未再次手术。结论 :孤立性蝶窦炎经CT或MRI等高清晰度的影像学检查加之以鼻窦内窥镜检查均可明确诊断 ,且经鼻窦内窥镜手术对其治愈有显著的优越性     

眶尖神经鞘瘤内镜手术切除疗效分析及术中神经保护策略

目的 探讨内镜手术治疗眶尖神经鞘瘤的疗效及术中神经保护策略。方法 回顾性分析2015年5月—2022年6月湘雅医院确诊并行内镜下手术治疗的9例眶尖神经鞘瘤的患者资料,术中均采用影像导航系统辅助,应用神经电生理监测技术监测动眼神经。采用描述性统计方法对患者进行分析,纳入临床、手术和预后资料等。结果 术后随访10~95个月,9例患者中8例肿瘤全切,1例次全切。全部患者的术前症状均得以好转或不同程度的改善,未出现手术死亡、颅内感染等手术并发症。9例患者术中均未发生相关神经损伤,术后均未出现神经功能障碍。结论 眶尖神经鞘瘤经内镜手术切除安全有效,配合术中应用影像导航系统和神经电生理监测技术具有全切率高、创伤小、并发症少及利于保护神经功能的优势。     

Transnasal endoscopic surgery for benign orbital tumors

Two cases of orbital tumor are presented, and the surgical technique by means of an endoscopic transnasal approach is discussed. In Case 1, a non-vascular, benign tumor was located inside the orbit, and it was able to be completely removed, without any complications. The tumor in Case 2 was also located inside the orbit, but it was determined to be a hemangioma based on the intraoperative pathology. To avoid eye complications arising from performance of the surgery in the presence of bleeding, it was decided to widely open the orbital lamina papyracea and periosteum, and perform only orbital decompression. The eye symptoms disappeared in both patients. Endoscopic transnasal surgery is indicated for benign orbital tumors that are medially located in the orbit. It can be thought that the eye symptoms can be alleviated by avoiding orbital pressure, regardless of whether-based on the intraoperative pathology-the tumor is completely removed or not.     

The evolution of sinus surgery in England in the last decade – An observational study

Background and objectiveSinus surgery has seen significant changes over the years with advancements in instruments, endoscopes and imaging. This study aimed to use Hospital Episode Statistics (HES) data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period. We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.MethodsData from HES was extracted for the years 2010–2019. The operative (OPCS-4) codes relevant to all sinus procedures between E12.1 and E17.9 were analysed. After examination of overall sinus related procedures, further subgroup analysis was performed with regards to open or endoscopic techniques.ResultsThe total number of sinus procedures performed between 2010 and 2019 was 89,495. There was an increase in endoscopic surgeries by 21.1% and a decrease of open surgeries 35.3% during this time. There was an overall increase in maxillary, frontal and sphenoid sinus procedures, with a decrease in ethmoid sinus and lateral rhinotomy operations. There was an increase in the proportion of endoscopic cases overall by 5.7% and for all sinuses individually.ConclusionOverall, we see an increase in sinus surgery over the last 9 years from 2010 to 2019. These findings are in keeping with our initial hypotheses. Although our data set is limited by coding, and lack of patient factors, it represents most, if not all, of the data in England over a large study period. It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.     

The evolution of sinus surgery in England in the last decade – An observational study

Background and objectiveSinus surgery has seen significant changes over the years with advancements in instruments, endoscopes and imaging. This study aimed to use Hospital Episode Statistics (HES) data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period. We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.MethodsData from HES was extracted for the years 2010–2019. The operative (OPCS-4) codes relevant to all sinus procedures between E12.1 and E17.9 were analysed. After examination of overall sinus related procedures, further subgroup analysis was performed with regards to open or endoscopic techniques.ResultsThe total number of sinus procedures performed between 2010 and 2019 was 89,495. There was an increase in endoscopic surgeries by 21.1% and a decrease of open surgeries 35.3% during this time. There was an overall increase in maxillary, frontal and sphenoid sinus procedures, with a decrease in ethmoid sinus and lateral rhinotomy operations. There was an increase in the proportion of endoscopic cases overall by 5.7% and for all sinuses individually.ConclusionOverall, we see an increase in sinus surgery over the last 9 years from 2010 to 2019. These findings are in keeping with our initial hypotheses. Although our data set is limited by coding, and lack of patient factors, it represents most, if not all, of the data in England over a large study period. It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.