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.     

Isolated sphenoid sinus diseases: report of 76 cases

CONCLUSION: Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. OBJECTIVES: The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years' experience. PATIENTS AND METHODS: Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. RESULTS: Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.     

孤立性蝶窦占位性病变的诊断与治疗

进一步认识孤立性窦占位性病变,提高对其诊断和治疗水平。方法在鼻内窥镜下摘除蝶窦囊肿２０例,行蝶窦探查术６例,经鼻外径路摘除囊肿３例,前颅底径路病变切除＋视神经减压术１例。结果２４例随０．５－４年无复发,１例术后不久囊肿复发,１例术后１年复发再次手术后随访１年无复发,１例正在放疗中３例失访。     

颅咽管瘤误诊为蝶窦囊肿1例

颅咽管瘤好发于鞍区,鞍上多见,少数在鞍内,或者鞍内、鞍上同时发生,也可偶见于鞍下鼻咽部、第三脑室内等,国内外已有不少关于蝶鞍区以外部位颅咽管瘤的报道,如鼻咽部［1］,蝶窦、筛窦［2］,额窦、筛窦［3］等,颅咽管瘤向蝶鞍下生长临床上非常少见,异位于蝶窦的颅咽管瘤极为罕见。现将我科收治的1例颅外颅咽管瘤患者的病历资料报道如下。     

双侧扩大蝶窦成形术在蝶窦病变中的应用

目的探讨双侧扩大蝶窦成形术在蝶窦病变中的应用价值。方法2012年12月～2017年6月,解放军南京总医院耳鼻咽喉头颈外科采用双侧扩大蝶窦成形术治疗蝶窦病变患者42例,随访6～53个月,观察其手术疗效及并发症。 结果15例难治性蝶窦炎患者术后蝶窦口开放良好,术腔清洁,均治愈;其余患者均彻底切除病灶,其中1例真菌性蝶窦炎伴颅内感染并发热患者术后予抗真菌治疗3个月后颅内病灶吸收,2例蝶窦癌、1例蝶窦脊索瘤患者及1例嗅神经母细胞瘤侵犯蝶窦及颅内患者术后均行放疗。42例患者术后除2例嗅觉减退及1例视力下降无明显好转外,余症状均明显缓解,未发生动脉性鼻出血、嗅觉减退及鼻中隔穿孔等并发症,术后患者术腔黏膜均上皮化良好,黏膜完全上皮化时间平均8.6周。2例蝶窦癌患者分别随访10、14个月,蝶窦脊索瘤患者随访10个月,均未复发;1例嗅神经母细胞瘤侵犯蝶窦及颅内患者随访8个月未复发。所有患者随访至今,均未发现蝶窦口再闭。结论采用双侧扩大蝶窦成形术治疗蝶窦病变,术野暴露清晰,蝶窦开放充分,术腔上皮化时间短,手术安全性高,术后随诊处置直观,是一种值得推广的手术方法。     

不同类型蝶窦开放治疗相关疾病

目的 提高对蝶窦开放术的认识,以选择合理术式治疗蝶窦及其相关疾病。方法 回顾分析于鼻内镜下行蝶窦开放术的患者42例的临床资料,其中行1型蝶窦开放术18例,相关疾病为细菌性蝶窦炎;2型蝶窦开放术19例,相关疾病为蝶窦真菌病、黏膜下囊肿及乳头状瘤;3型蝶窦开放术5例,相关疾病为蝶筛窦黏液囊肿、脑垂体瘤、岩尖胆脂瘤、岩尖胆固醇肉芽囊肿。结果 所有患者均治愈,随访半年至3年,无复发。其中1例脑垂体瘤患者术后出现脑脊液鼻漏,经保守治疗后治愈。结论 不同类型蝶窦开放不但可以治疗不同蝶窦疾病,还可作为经鼻内镜颅底手术的径路,均可获得良好效果。     

孤立性蝶窦疾病159例临床分析

目的:分析孤立性蝶窦疾病的诊断与治疗方法,使其得到早期诊断、及时干预和治疗,以降低误诊率。方法:对159例孤立性蝶窦疾病患者进行回顾性分析。结果:孤立性蝶窦疾病患者最常见的临床症状是头痛(79.87%,127/159)。在159例患者中,60例(37.74%)为蝶窦囊肿,44例(27.67%)为单纯性蝶窦炎,31例(19.50%)为真菌性蝶窦炎,5例(3.14%)为蝶窦息肉,3例(1.89%)为骨纤维异常增殖症,2例(1.26%)为内翻性乳头状瘤,3例(1.89%)为脊索瘤,3例(1.89%)为鳞状细胞癌,3例(1.89%)为恶性淋巴瘤,2例(1.26%)为神经内分泌癌,2例(1.26%)为嗅神经母细胞瘤,1例(0.63%)为恶性纤维组织细胞瘤。术后随访10个月～4年,鼻内镜术后多数患者转归良好。结论:孤立性蝶窦疾病常无特异性症状及体征,最常见的临床症状是头痛,其次是视力障碍,鼻内镜下蝶窦开放术是首选的治疗方法。     

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.     

孤立性蝶窦病变误诊分析

目的提高对孤立性蝶窦病变的诊断水平,降低该病的误诊率。方法回顾1991～1998年12例孤立性蝶窦病变的病例,分析其误诊因素。结果12例患者中9例为蝶窦炎性病变,其中5例首诊时曾误诊。误诊病种包括视神经炎2例,神经痛、肺结核和癫痫各1例;3例为蝶窦恶性肿瘤,首诊时均曾误诊,误诊疾病分别为鼻窦炎、眼部炎症及鼻出血。结论孤立性蝶窦病变并非罕见,但临床症状无特征性表现,医师对该病认识不足是导致误诊的主要原因。CT与磁共振成像（magnetic resonance     

Isolated sphenoid sinus opacification: A systematic review

Objective

Unilateral sphenoid sinus opacification (SSO) on imaging is a common incidental radiologic finding. Inflammatory sinus disease is rarely isolated to one sinus cavity therefore SSO raises the potential for neoplastic etiology. The clinical significance of SSO was evaluated and compared to maxillary sinus opacification (MSO).

Isolated sphenoid sinus diseases: report of 39 cases

OBJECTIVE: To detail the underlying pathological conditions, symptoms, signs, and outcomes of patients with isolated sphenoid sinus involvement. DESIGN: A retrospective survey. SETTING: An academic referral center of a university hospital. PATIENTS: All 39 patients, aged 7 to 85 years, treated in the Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland, from 1988 through 1997 for isolated sphenoid sinus disease. RESULTS: Sinusitis was characterized as acute in 26 patients, subacute in 5 (including 1 pyocele), and chronic in 8 (including 2 fungal infections). No tumors were found. Isolated sinus cysts were excluded from the study. Headache, the main symptom in 32 patients (82%), was localized most commonly on the vertex. Other common complaints were rhinitis, dizziness, eye symptoms, and fever. In 2 patients, the finding was occult. Eight patients (21%) presented with cranial nerve deficits, and 1 patient had an intracranial complication. Sinus irrigation was performed in 16 patients (41%) and sphenoidotomy was performed in 10 (26%). Fifteen patients (38%) were treated with antibiotic drugs alone. Within 3 months, 31 (84%) of 37 patients had recovered from the illness; 5 still experienced headaches despite having normalized radiographic findings; and 1 had permanent unilateral visual loss. Two patients were lost to follow-up. CONCLUSIONS: Sphenoid sinus opacity is mostly inflammatory in origin. Despite the benign nature of the disease, there is a risk of complications with high morbidity and mortality. Early and, if necessary, aggressive therapy to guarantee drainage of the sinus is recommended.     

孤立性真菌球性蝶窦炎

目的提高对孤立性真菌球性蝶窦炎的认识,以期早期诊治。方法回顾性分析9例孤立性真菌球性蝶窦炎的临床表现、影像学特点、治疗结果和随访情况,并复习相关文献;全部病例在鼻内镜下行蝶窦开放术。结果术后6周术腔逐渐上皮化,术后8～10周可出现清洁、规整的术腔;随访6～14个月,无复发病例。结论孤立性真菌球性蝶窦炎症状无特异性,不易及时确诊;鼻内镜和CT检查能提高术前诊断率,病理学检查可明确诊断;鼻内镜鼻窦手术治疗真菌球性蝶窦炎优势明显。     

导航在鼻内镜下蝶窦手术的应用

目的 探讨影像导航系统在鼻内镜下蝶窦病变手术的应用及优势。方法 我们应用影像导航系统结合鼻内镜对37例蝶窦病变行手术,其中单纯蝶窦炎21例,干酪性蝶窦炎6例,蝶窦囊肿10例(其中黏液囊肿6例,黏膜囊肿4例)。患者均采用气管插管全麻,全麻后通过导航定位注册成功,根据手术中的需要标定探针或吸引器作为术中的定位设备,在鼻内镜下,通过使用导航定位设备以判断术中器械到达的具体位置、了解局部解剖关系,确定蝶窦位置,开放蝶窦,清除病变;针对蝶窦囊肿,则仅切除囊肿前壁或前下壁,凿孔孔径约1cm×0.5cm,勿需清除所有囊壁;蝶窦黏膜囊肿则需将囊肿完全清除。结果 37例手术均取得了成功,无术中、术后并发症发生。结论 影像导航系统结合鼻内镜治疗蝶窦病变可以有效地提高手术疗效和避免并发症的发生。     

Metastatic carcinoma to the sphenoid sinus case report and review of the literature

Summary Metastatic carcinoma to the sphenoid sinus is a rare event. A case of metastatic adenocarcinoma from the prostate gland to the sphenoid sinus and diagnosed with the aid of immunoperoxidase staining is presented. A concurrent review of the literature uncovered only 17 previously reported cases of carcinoma metastatic to the sphenoid sinus. Among these cases, adenocarcinoma from the large bowel and prostate gland predominated.     

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。     

蝶窦外侧隐窝真菌球的临床特征及手术治疗

目的探讨蝶窦外侧隐窝真菌球的临床特征及经鼻内镜下手术的疗效。方法回顾性分析2005年2月～2011年2月收治的21例蝶窦外侧隐窝真菌球患者的临床资料及手术后的随访结果。所有蝶窦外侧隐窝真菌球患者中,颞部头痛或眼外侧胀痛患者14例;涕中带血5例、视力下降2例。均行鼻内镜蝶窦开放手术,其中12例经嗅裂蝶窦开口处入路,5例经蝶窦前下壁开窗人路,4例经翼突根部入路。结果术中及术后所有患者均无并发症发生。术后随访12～24个月,21例患者临床症状均消失,术腔黏膜生长良好,蝶窦口开放良好,无复发病例。结论鼻窦CT检查有助于蝶窦外侧隐窝真菌球的诊断,鼻内镜手术具有微创和病灶获得彻底清除的优点,对于防止术后复发具有重要的意义。     

蝶窦囊肿诊治47例分析

目的：提高对蝶窦囊肿的认识,以利于其诊断和治疗,方法：回顾性分析蝶窦囊肿４７例,总结其发病趋势、临床表现,影像学特征及治疗效果。结果：蝶窦囊肿最主要的临床症状为头痛,约占６４％;其次为眼部症状,再次为鼻部症状。蝶窦囊肿最易易及视神经,影响者视力,早期手术有利于神经力的恢复。鼻内窥镜下蝶窦囊肿摘除了术有损伤小,出血少,痛苦轻,手术时间短、安全,术后恢复快等优点。结论：ＣＴ、ＭＲＩ和鼻内窥镜的应用,提     

以头痛或眼部症状为首发症状的孤立性蝶窦疾病

目的：提高对孤立性蝶窦疾病的认识,以降低其误诊、漏诊的发生率。方法：分析22例孤立性蝶窦疾病患者的临床表现和鼻内镜治疗的优势。结果：12例行鼻内镜蝶窦开放术,7例行鼻外筛窦进路手术,3例行抗感染、激素、神经营养药等治疗,头痛症状全部消失,视力不同程度恢复。眼球运动障碍改善,随访3-6个月,1例症状复发,再次行鼻内镜手术后症状缓解。1例腺样囊性癌术后放疗,随访3年无复发。结论：以头痛和（或）眼部症状为主的孤立性蝶窦疾病,容易造成误诊、漏诊;CT、MRI和鼻内镜的应用,提高了对该病的诊疗水平;鼻内镜手术是治疗孤立性蝶窦疾病的首选。     

孤立性蝶窦炎症性疾病

目的提高对孤立性蝶窦炎症性疾病的认识,争取早期诊断和及时治疗,避免产生严重并发症.方法回顾性分析23例孤立性蝶窦炎症性疾病的临床表现、影像学特点、治疗结果和随访情况,并复习相关文献.结果本病主要症状为头痛和视觉损害,全部病例行鼻内镜下蝶窦开放手术.随访6～14个月,无复发.结论孤立性蝶窦炎症性疾病症状无特异性,不易及时确诊;鼻内镜和CT检查能提高术前诊断率,功能性鼻内镜手术在蝶窦炎症性疾病的治疗上具有明显优势.