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。     

经鼻内镜动力系统辅助蝶窦手术

目的:探讨经鼻内镜结合动力系统在孤立性蝶窦疾病手术中的作用。方法:回顾性分析45例接受经鼻内镜治疗的孤立性蝶窦疾病病人资料。结果:术后随访8～39个月(平均23．5月)，手术有效率91．1％。38例头痛均消失，14例视力改善(77．8％)，3例复视恢复(60．0％)，鼻阻、粘脓性涕、假性脑脊液鼻漏等症状均恢复。1例并发脑脊液鼻漏，经修补治愈。结论:经鼻内镜结合动力系统手术是治疗孤立性蝶窦疾病安全、有效的方法。     

孤立性蝶窦疾病的诊断和治疗

目的探讨孤立性蝶窦疾病的诊断和治疗方法.方法对本科2000年7月～2003年7月收治的孤立性蝶窦疾病16例,对其临床表现及治疗经过进行分析.结果16例中,炎性病变6例;囊肿5例;霉菌性蝶窦炎4例;恶性肿瘤1例.临床表现以头痛,眼部症状如上睑下垂、复视、视力下降为主.结论对不明原因的头痛、视力下降患者应高度怀疑蝶窦病变,宜及早进行鼻内镜、CT、MRI检查和早期治疗.鼻内镜下经鼻腔蝶窦进路是治疗孤立性蝶窦疾病的首选术式.     

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。     

孤立性蝶窦疾病的诊断及其鼻内镜手术治疗

目的：探讨孤立性蝶窦疾病的临床特点、影像学特征和鼻内镜手术的疗效。方法：38例孤立性蝶窦疾病患者,35例行鼻窦CT（其中5例同时行MRI）,3例行单纯鼻窦MRI,1例行脑池CT造影。所有患者均行鼻内镜下蝶窦开放术,其中有33例采用经鼻腔嗅裂径路,5例采用经前筛一后筛径路（即Messerklinger技术）。结果：术后随访6个月以上,34例病情完全控制,4例部分控制。术中和术后均未出现严重并发症。结论：孤立性蝶窦疾病临床症状不典型,无特异性,鼻部检查多无阳性体征,仅有以头痛为主诉的神经系统症状,早期常难以确诊。鼻窦CT和MRI是诊断孤立性蝶窦炎的最佳手段,而鼻内镜手术则是治疗该病的首选方法。     

孤立性蝶窦疾病的临床分析

目的:探讨孤立性蝶窦疾病的临床特点和治疗方法,提高首诊准确率和治愈率,避免产生严重并发症.方法:回顾性分析46例孤立性蝶窦疾病患者的临床表现、影像学特点、病理类型和外科治疗效果.结果:本病主要症状为头痛和视力损害;影像学检查见蝶窦占位,部分可有骨质破坏;病理检查显示蝶窦炎症8例,真菌病19例,囊肿10例,息肉9例;全部患者经鼻内镜蝶窦开放手术.随访6个月以上,绝大部分患者症状明显好转,检查蝶窦开口通畅,窦腔无分泌物,窦壁光滑.结论:孤立性蝶窦疾病症状无特异性,鼻内镜和CT或MRI检查能提高术前诊断率,内镜鼻窦手术是治疗的首选术式.     

蝶窦恶性肿瘤的诊断与治疗

目的进一步认识蝶窦恶性肿瘤的临床特点、鼻内镜及影像学表现、误诊疾病及治疗效果,以提高诊断与治疗水平。方法对9例蝶窦肿瘤患者的临床资料进行回顾性分析。临床表现为头痛8例,视力下降3例,涕中带血、鼻塞3例,脑神经麻痹2例。误诊为蝶窦炎3例,鼻咽癌2例,脑梗塞、脑积水各1例。手术加术后放射治疗7例,单纯放射治疗1例。结果1例内翻性乳头状瘤恶变随访6年无复发;1例神经内分泌癌随访3年生存;4例治疗后2～3年内死亡,其中1例恶性黑色素瘤治疗后3年死于心肌梗塞,1例腺样囊性癌治疗后3年死亡,2例鳞状细胞癌治疗后2年内死亡:1例低分化鳞状细胞癌和1例恶性黑色素瘤随访1年生存;1例低分化腺癌失访。结论蝶窦恶性肿瘤早期无特殊症状,临床容易误诊和漏诊。对不明原因头痛、视力下降、涕中带血的患者应及早行鼻内镜和鼻窦CT、MRI检查,鼻内镜检查发现蝶筛隐窝小息肉,应及时活检以明确诊断。     

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,骨壁增厚,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.     

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。     

孤立性蝶窦疾病的诊断和治疗

目的探讨孤立性蝶窦疾病的临床表现,提高首诊准确率,并寻求合适的治疗方法。方法22例术前均行CT或MRI和鼻内镜检查,术中取病变组织送病理明确诊断。结果经鼻内镜手术后随访5个月至两年半,22例症状明显好转,蝶窦前壁通畅,窦壁光滑。结论孤立性蝶窦疾病并非罕见,头痛是常见非特异性症状,可伴有视力下降等颅神经损害及血性涕等症状。鼻内镜手术是治疗本病的首选术式。     

蝶窦恶性肿瘤误诊原因分析

目的：探讨蝶窦恶性肿瘤的临床特点、治疗效果和误诊原因,以提高诊疗水平。方法：将我科1996～2005年间收治的18例蝶窦恶性肿瘤进行回顾性分析。结果：蝶窦恶性肿瘤以鼻咽癌浸润性为最多见,其次为脊索瘤和非霍奇金淋巴瘤,临床表现为头痛（78％）、视力改变（50％）、颅神经麻痹（39％）、回吸性涕血或鼻出血（11％）;临床诊断误诊率达56％。结论：蝶窦恶性肿瘤的影像学诊断有一定局限性,应常规行鼻内镜检查。     

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.     

Evaluation and surgical management of isolated sphenoid sinus disease

OBJECTIVES: To evaluate the pathologic conditions, preoperative evaluation, treatment, and clinical outcomes associated with sphenoid sinus disease. DESIGN: Retrospective study. SETTING: Tertiary university-based referral center. PATIENTS: All patients with isolated sphenoid sinus disease managed surgically or in which surgery was considered a primary treatment option. MAIN OUTCOME MEASURES: Demographic data, presenting signs and symptoms, endoscopic and imaging findings, surgical management, surgical pathology, and clinical outcomes were investigated in patients presenting with sphenoid sinus disease to the Medical College of Wisconsin, Milwaukee, between January 1, 1991, and December 31, 2001. RESULTS: The study population included 17 women and 12 men with a mean age of 52.3 years (range, 15-82 years). The most common presenting symptom was headache (20 patients [69%]). Imaging evaluation included computed tomography and/or magnetic resonance imaging studies in all cases. Sphenoid sinus abnormality was variable and included sinusitis (11 patients [38%]), tumor (7 [24%]), mucocele (5 [17%]), fungal process (3 [10%]), and cerebrospinal fluid fistula (3 [10%]). Twenty-one cases (72%) were managed endoscopically and 4 (14%) were managed with a transseptal approach. One patient (3%) underwent combined extracranial-endoscopic transnasal approach, while another (3%) underwent a midface degloving approach. The remaining 2 patients (7%) did not undergo surgical intervention. CONCLUSIONS: Given the high prevalence of noninflammatory lesions within the sphenoid sinus, thorough preoperative evaluation is imperative. Initially, this should include nasal endoscopy and computed tomography to help define the location, extent, and character of the lesion. In some cases, magnetic resonance imaging may help further define the nature and extent of a lesion. Angiography should be considered if a vascular lesion is suspected. The clinical and imaging findings should all be taken into consideration when the surgical approach is planned.     

Isolated sphenoid sinus lesions: a clinical analysis of 44 cases

OBJECTIVE: We reviewed isolated sphenoid sinus lesion (ISL), a relatively uncommon entity found mostly in departments other than otolaryngology. STUDY DESIGN: We retrospectively studied 44 cases of ISL at the Department of Otolaryngology, Kagoshima City Hospital, Kagoshima, Japan, for the 5 years between 1999 and 2003. METHODS: Data was obtained for each patient regarding age, present symptoms, first department visit, pathological classification, and therapy. RESULTS: Eighty percent of patients first visited departments other than otolaryngology. Of these, 32 had inflammatory disease, 8 mucocele, 1 a benign tumor, and 3 malignant tumors. The most common symptoms were headache at 59% followed by ocular symptoms at 27%. Ocular symptoms included ocular pain in 60% of those with inflammatory disease, visual disturbance in 63% of those with mucocele, and diplopia in all of those with neoplasms. CONCLUSION: The type of ocular symptom largely depends on ISL pathology. Patients with headaches and diplopia have a high ratio of malignant neoplasms. Endoscopic sinus surgery was useful in diagnosing and treating ISL in cases in which conservative therapy was ineffective. It is most important to differentiate pathological disease that requires early diagnosis and therapy such as acute inflammatory disease, mucocele with visual disturbance, and malignant tumors.     

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.