2,013 results on '"sphenoid sinus"'
Search Results
2. Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery
- Author
-
Luca D'Angelo, Daniele Armocida, Alessandro Caporlingua, Antonio Santoro, Francesca Rizzo, and Francesco Paglia
- Subjects
medicine.medical_specialty ,Sphenoid Sinus ,Planum temporale ,Neurosurgery ,Nose ,Brain tumor ,Intrasellar region ,Neuroendoscopy ,Pituitary gland ,Transphenoidal approach ,Posterior wall ,medicine ,Humans ,Dicom viewer ,Volume reconstruction ,Trans sphenoidal ,Sinus (anatomy) ,Preoperative planning ,business.industry ,Volume rendering ,Endoscopy ,General Medicine ,medicine.anatomical_structure ,Surgery ,Neurology (clinical) ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Background The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. Methods For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. Results For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n = 3), inexpert (n = 3) and the entire group of observers (n = 6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. Conclusions The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.
- Published
- 2022
- Full Text
- View/download PDF
3. Anatomical relationship of pterygoid process pneumatization and vidian canal
- Author
-
Nanditha Lakshman, Fahad Bapu Thondupadath Assanar, and Viveka S
- Subjects
Pneumatização ,Pterygoid process ,Sphenoid Sinus ,Carotid arteries ,Sphenoid bone ,Osso esfenoide ,Canal vidiano ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,medicine.artery ,Sphenoid Bone ,otorhinolaryngologic diseases ,medicine ,Humans ,SPHENOID SINUSES ,030223 otorhinolaryngology ,Sinus (anatomy) ,Skull Base ,Vidian canal ,business.industry ,Anatomy ,Pneumatization ,medicine.anatomical_structure ,Otorhinolaryngology ,Tomografia computadorizada ,Coronal plane ,Anatomical relationship ,CT scanning ,Medial pterygoid plate ,Internal carotid artery ,Tomography, X-Ray Computed ,business ,Carotid Artery, Internal ,030217 neurology & neurosurgery - Abstract
Introduction The vidian canal acts as landmark for the identification of the petrous carotid artery, especially during extended endoscopic endonasal approaches in cranial base surgeries. In order to localize the canal and to understand the relationship of pneumatization of pterygoid process to the type of vidian canal, this study was designed. Objectives The objective was to describe the anatomical relationship of pneumatization of the pterygoid process with types of vidian canal. The length of vidian canal, relationship to medial plate of pterygoid process and relationship to the petrous part of internal carotid artery were evaluated. Methods Head computer tomography scans of 52 individuals for suspected paranasal pathology were studied. The degree of sphenoid sinus pneumatization, pterygoid process pneumatization and types of vidian canal (type 1, 2 and 3) were noted. The length of vidian canal, distance from the plane of medial pterygoid plate and relation of vidian canal to the junction of petrous and Gasserian (ascending) part of internal carotid artery was noted. Results 46 (92%) sphenoid sinuses were of the sellar variety. Out of 104 sides that were studied, 57 sides demonstrated a pneumatised pterygoid process and 47 were not pneumatised. In 49 sides (47.1%) the vidian canal was on the same plane as that of the medial pterygoid plate in the coronal section. The vidian canal partially protruded into the sphenoid sinus (type 2) was the most common type (50.9%), found both on right and left sides. There is a statistically significant association between the pterygoid process pneumatization and occurrence of type 2 and type 3 vidian canal configuration. The average length of the vidian canal was 16.16 ± 1.8 mm. In 96 sides, the anterior end of vidian canal was inferolateral to petrous part of internal carotid artery in the coronal plane. Conclusion Pneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration. Resumo Introdução O canal vidiano atua como ponto de referência para a identificação da artéria carótida petrosa, especialmente durante abordagens endoscópicas endonasais extensas em cirurgias de base do crânio. Este estudo foi projetado com o objetivo de localizar o canal vidiano e entender a relação da pneumatização do processo pterigoide sobre o tipo de canal. Objetivos Descrever a relação anatômica da pneumatização do processo pterigoide com os tipos de canal vidiano. Foram avaliados o comprimento do canal vidiano, a relação com a placa medial do processo pterigoide e com a porção petrosa da artéria carótida interna. Método Foram estudadas tomografias computadorizadas de 52 indivíduos submetidos a tomografia computadorizada de cabeça por suspeita de doença em seio paranasal. Foram observados o grau de pneumatização do seio esfenoidal, a pneumatização do processo pterigoide e os tipos de canal vidiano (Tipos 1, 2 e 3). Observou-se o comprimento do canal vidiano, a distância do plano da placa pterigoide medial e a relação do canal vidiano com a junção da porção petrosa e gasseriana (ascendente) da artéria carótida interna. Resultados Eram do tipo selar 46 (92%) seios esfenoidais. Dos 104 lados estudados, 57 eram do processo pterigoide pneumatizado e 47 não eram pneumatizados. Em 49 lados (47,1%), o canal vidiano estava no mesmo plano que o da placa pterigoide medial na seção coronal. O canal vidiano em protusão parcial no seio esfenoidal (tipo 2) foi o tipo mais comum (50,9%), encontrado nos lados direito e esquerdo. Houve uma associação estatisticamente significante entre a pneumatização do processo pterigoide e a ocorrência da configuração do canal vidiano tipo 2 e tipo 3. O comprimento médio do canal vidiano foi de 16,16 ± 1,8 mm. Em 96 lados, a extremidade anterior do canal vidiano era inferolateral à porção petrosa da artéria carótida interna no plano coronal. Conclusão A pneumatização do processo pterigoide indica a configuração do canal vidiano tipo 2 ou tipo 3.
- Published
- 2022
- Full Text
- View/download PDF
4. Ectopic sphenoid sinus pituitary adenoma masquerading as metastatic head and neck cancer
- Author
-
Jian Li Tan, Alvin Yong Quan Soon, Bundele Manish, and Augustine Yui Ler Chai
- Subjects
Adenoma ,Male ,medicine.medical_specialty ,Sphenoid Sinus ,Case Report ,Salivary duct carcinoma ,Metastatic carcinoma ,03 medical and health sciences ,0302 clinical medicine ,Clivus ,Pituitary adenoma ,medicine ,Humans ,Pituitary Neoplasms ,030223 otorhinolaryngology ,Sinus (anatomy) ,Aged ,Fluorodeoxyglucose ,business.industry ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Nasopharyngeal carcinoma ,030220 oncology & carcinogenesis ,Chordoma ,Radiology ,business ,Paranasal Sinus Neoplasms ,medicine.drug - Abstract
A 68-year-old Chinese man was found to have a lobular mass in the sphenoid sinus which extended to the clivus and the roof of the nasopharynx on a staging MRI scan performed for his high-grade parotid salivary duct carcinoma. Further positron emission tomography scan showed that this lesion was fluorodeoxyglucose (FDG) avid. This proved to be a diagnostic dilemma. The patient underwent a total parotidectomy, left selective neck dissection and a transphenoidal biopsy of his nasal lesion. Final histology revealed that this lesion was a synchronous ectopic sphenoid sinus pituitary adenoma (ESSPA). Initial differential diagnoses that were considered included a chordoma, metastatic carcinoma and nasopharyngeal carcinoma. However, an important differential with a neoplastic appearance and a tendency for positive FDG uptake is an ESSPA. It requires dedicated immunohistochemical staining to diagnose, and its mainstay of treatment is surgical excision.
- Published
- 2023
5. Posterior Transposition of the Frontal Bridging Veins Together with Sphenoparietal Sinus: A Simple Technique to Widen the Surgical Corridor During Pterional Clipping of the Anterior Communicating Artery
- Author
-
Atsuya Akabane, Sho Tsunoda, Tomohiro Inoue, and Masafumi Segawa
- Subjects
Male ,Sphenoid Sinus ,medicine.medical_treatment ,Sphenoparietal sinus ,Brain surface ,Neurosurgical Procedures ,Venous congestion ,Parietal Lobe ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Brain function ,Aged ,business.industry ,Bridging veins ,Intracranial Aneurysm ,Anatomy ,Clipping (medicine) ,Middle Aged ,Surgical Instruments ,Cerebral Veins ,Anterior communicating artery ,medicine.anatomical_structure ,Frontal lobe ,cardiovascular system ,Female ,Surgery ,Neurology (clinical) ,business - Abstract
Background High-positioned and/or superoposteriorly directed anterior communicating artery aneurysms can be treated by direct clipping using the pterional (fronto-temporo-sphenoidal) approach. This procedure, however, requires stronger retraction of the frontal lobe. Hence, preservation of the prominent frontal bridging veins (FBVs) draining into the sphenoparietal sinus (SPS) remains a significant challenge in preventing postoperative venous congestion. Methods We developed a technique to release the tension on the FBVs by pulling them together with the SPS epidurally. In 2 patients, who had presented with high-positioned and/or superoposteriorly directed anterior communicating artery aneurysms, we peeled off the arachnoid surrounding the FBVs and detached it from the brain surface. We further released the veins by moving them posteriorly, together with the SPS epidurally. Results Using this technique, we established a wide corridor through a more lateral transsylvian trajectory with effective posterior retraction of the frontal lobe and were successful in clipping and obliterating the aneurysms. Conclusions Open clipping of unruptured intracranial aneurysms requires accuracy to preserve higher brain function. Our technique was successful in both patients, and preserving the FBVs could be useful in the treatment of such aneurysms.
- Published
- 2021
- Full Text
- View/download PDF
6. Indications and advantages of endoscopic trans-sphenoid approach for petrous apex lesions: two case reports
- Author
-
Hitesh Verma, Alok Thakar, and Smile Kajal
- Subjects
Adult ,medicine.medical_specialty ,Sphenoid Sinus ,business.industry ,Petrous Apex ,Endoscopy ,General Medicine ,Cholesterol ,Otorhinolaryngology ,Sphenoid Bone ,Humans ,Medicine ,Radiology ,business ,Petrous Bone - Abstract
BackgroundThe choice of surgical approach for a petrous apex lesion depends on its relationship with the internal carotid artery, degree of medial expansion and pathology. The correct identification of patients who will benefit from this approach is necessary.Case reportsTwo adult patients presented with a lesion in the left petrous apex. Computed tomography showed a homogeneous mass extending anteromedially, and abutting the internal carotid artery and the sphenoid sinus in both patients. Using magnetic resonance imaging, a third recurrence of cholesterol granuloma in case one and cholesteatoma in case two were diagnosed. Both patients underwent trans-sphenoid excision, as the sphenoid sinus was well pneumatised and the lesion was medial to the internal carotid artery.ConclusionNasal endoscopic access to the petrous apex via the trans-sphenoid corridor should be preferred for benign lesions extending anteromedially in cases where lateral access is impeded by the internal carotid artery, the labyrinth and the facial nerve, and anterior trans-sphenoidal access offers a low-morbidity alternative.
- Published
- 2021
- Full Text
- View/download PDF
7. How important is the Sphenoseptal cell in identifying the skull base? Recent incidence and demonstration of endoscopic surgical steps
- Author
-
Mehmet Hakan Korkmaz, Cem Saka, Gökhan Toptaş, Emel Çadalli Tatar, Bülent Öcal, and Tuğçe Pütürgeli Özer
- Subjects
medicine.medical_specialty ,Sphenoid Sinus ,Anatomical structures ,Article ,otorhinolaryngologic diseases ,Humans ,Medicine ,Sinus (anatomy) ,Retrospective Studies ,Skull Base ,business.industry ,Incidence (epidemiology) ,Endoscopy ,anatomic variation ,General Medicine ,Sphenoseptal cell ,Endoscopic sinus surgery ,Skull ,medicine.anatomical_structure ,Otorhinolaryngology ,Cavernous sinus ,Optic nerve ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the Otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell. Materials and methods In this study 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC, that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery. Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). Conclusion Although an SCC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.
- Published
- 2021
- Full Text
- View/download PDF
8. The clinical features of endoscopic treated isolated sphenoid sinus diseases
- Author
-
Ching-Wen Chiang, Chih-Feng Lin, Hsuan-Chih Lin, Te-Huei Yeh, Chih-Chen Chao, and Yi-Tsen Lin
- Subjects
Fungal infection ,medicine.medical_specialty ,Medicine (General) ,Sinonasal neoplasm ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,R5-920 ,Paranasal Sinus Diseases ,medicine ,Humans ,Major complication ,Sinusitis ,Retrospective Studies ,Cerebrospinal fluid leak ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Sphenoid sinus ,Surgery ,Bloody ,030220 oncology & carcinogenesis ,Cavernous sinus ,Etiology ,030211 gastroenterology & hepatology ,Tomography, X-Ray Computed ,business - Abstract
Background Isolated sphenoid sinus disease (ISSD) is a rare clinical entity with potentially serious complications. The etiological distribution of ISSD varies among different areas and ethnicities. We aimed to investigate the clinical features of patients with endoscopic treated ISSD. Methods We retrospectively reviewed all patients with ISSD who had undergone endoscopic surgery between April 2013 and May 2019. The patient records were reviewed for demographic data, clinical presentations, endoscopic and imaging study findings, surgical outcomes and complications. Results A total of 37 patients with ISSD who underwent surgery were recruited. We divided patients into three groups according to etiology, including inflammatory diseases (78.4%), neoplasms (13.5%) and spontaneous cerebrospinal fluid (CSF) leaks (8.1%); fungal ball (62.2%) constituted the major cause of ISSD. Overall, the most common presenting symptom was headache or facial pain (65.5%). The endoscopic findings of bloody discharge and tumor lesions were mainly from the neoplasm group. Bony defects were more obvious on computed tomography in the neoplasm and CSF leak groups. Magnetic resonance imaging revealed a higher rate of involvement of the cavernous sinus (40.0%) and intracranial extensions (40.0%) in the neoplasm group. To summarize the surgical outcomes, the success rate was 97.1%, and the major complication rate was 5.4%. Conclusion ISSD represents a variety of etiologies, mostly comprising fungal ball in our area, while there is still a considerable proportion of ISSDs attributed to neoplasm and CSF leak. Untreated ISSD can result in serious complications. We recommend early surgical intervention for all patients with ISSD.
- Published
- 2021
9. Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus
- Author
-
Kyoung Ryul Lee, Yoo Hyung Kim, Young Soo Je, Jung Hee Kim, Yong Hwy Kim, and Hwan Sub Lim
- Subjects
Adult ,Male ,Neuroendocrine diseases ,Vasopressin ,medicine.medical_specialty ,Time Factors ,Optimal cutoff ,Pituitary diseases ,Sphenoid Sinus ,genetic structures ,medicine.medical_treatment ,Science ,Endocrine cancer ,Normal serum ,Gastroenterology ,Article ,Neurosurgical Procedures ,Postoperative Complications ,Copeptin ,Internal medicine ,medicine ,Humans ,Postoperative Period ,Aged ,Retrospective Studies ,Transsphenoidal surgery ,Multidisciplinary ,business.industry ,Glycopeptides ,Middle Aged ,medicine.disease ,Predictive value ,Diabetes Insipidus, Neurogenic ,ROC Curve ,Neuroendoscopy ,Preoperative Period ,Diabetes insipidus ,Medicine ,Female ,Pituitary surgery ,business - Abstract
Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P P = 0.002, − 27.2%). Three months postoperative copeptin level
- Published
- 2021
10. A Case of Small Cell Carcinoma Originated from Sphenoid Sinus in Patient with Recurrent Pituitary Tumor
- Author
-
Sangjun Kim, Min Gyoung Pak, Daeyeon Kim, and Woo Yong Bae
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,sphenoid sinus ,radiosurgery ,pituitary adenoma ,postoperative period ,medicine.disease ,Small-cell carcinoma ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Otorhinolaryngology ,RF1-547 ,030220 oncology & carcinogenesis ,medicine ,Medicine ,In patient ,Recurrent pituitary tumor ,030223 otorhinolaryngology ,business ,small cell carcinoma ,Sinus (anatomy) - Abstract
Small cell carcinoma (SmCC) is a type of neuroendocrine tumor commonly originating in the lung, with only about 2-4% of cases arising at extrapulmonary sites. Extrapulmonary SmCC of the head and neck has a poor prognosis and a high rate of distant metastasis. The paranasal sinus is a rare location for extrapulmonary SmCC and only a few related papers have been published to date. We report a rare case of SmCC originating from the sphenoid sinus in a patient with a recurrent pituitary tumor with a literature review.
- Published
- 2021
- Full Text
- View/download PDF
11. The Comparison of Piriform Aperture, Paranasal Sinuses, and Cranial Dimensions
- Author
-
Tugrul Ormeci, Alper Atasever, and Esin Topal
- Subjects
Adult ,Sphenoid Sinus ,Bone deformations ,Calvaria ,Piriform aperture ,Head trauma ,Computed Tomography ,Paranasal Sinuses ,medicine ,Humans ,Retrospective Studies ,business.industry ,Morphometry ,Skull ,Anatomic Variation ,General Medicine ,Anatomy ,Maxillary Sinus ,Positive direction ,Endoscopic sinus surgery ,Paranasal sinuses ,medicine.anatomical_structure ,Otorhinolaryngology ,Frontal Sinus ,Surgery ,Surgical history ,Piriform Aperture ,business - Abstract
Objective: Piriform aperture, paranasal sinuses, and the cranium dimensions were compared with each other and we investigated the alterations depending on the age and gender in these structures. Before the endoscopic sinus surgery, anatomic variations in sinusoidal region and the occurring differences should be considered. The detection of these variations plays important roles in the prevention of complications which may happen in surgery or in obtaining a successful surgical result. Materials and Methods: Piriform aperture maximum width, frontal sinuses, sphenoidal sinuses, maxillary sinuses, and craniumwidths and height length was measured from the regions that we were determined. Three hundred ninety three cases'computed tomography images were compared. The individuals without any head trauma, pathology, and surgical history in sinusoidal region were analyzed retrospectively. The detected measurements were studied among the paranasal sinuses, piriform aperture, and calvaria dimensions. Results: It was observed that the dimensions of paranasal sinuses were decreased and the dimension of piriform aperture was increased depending on age. In all individuals, a relationship in positive direction in a manner that piriform aperture width increases as the size of the cranium width increases. Morphologic alterations take place in the dimensions of paranasal sinuses as a result of bone deformations occurring in the bone structure depending age and gender in adult individuals.
- Published
- 2021
- Full Text
- View/download PDF
12. Morphometric characteristics of the sphenoid sinus and potential influencing factors: a retrospective assessment using cone beam computed tomography (CBCT)
- Author
-
Thomas von Arx, Kuofeng Hung, Michael M. Bornstein, Deepal Haresh Ajmera, Pradeep Singh, and Andy Wai Kan Yeung
- Subjects
Adult ,Male ,Cone beam computed tomography ,Adolescent ,Sphenoid Sinus ,610 Medicine & health ,Young Adult ,03 medical and health sciences ,Sex Factors ,AGE ,0302 clinical medicine ,Maximum diameter ,Extension ,otorhinolaryngologic diseases ,Humans ,Medicine ,030223 otorhinolaryngology ,Pathological ,Sinus (anatomy) ,Aged ,Retrospective Studies ,Aged, 80 and over ,Science & Technology ,Volume ,business.industry ,CBCT ,General Medicine ,Human physiology ,Cone-Beam Computed Tomography ,Middle Aged ,Anatomy & Morphology ,Sphenoid sinus ,ANATOMY ,Cbct imaging ,Middle age ,medicine.anatomical_structure ,Female ,Original Article ,Anatomy ,3-Dimensional ,business ,Nuclear medicine ,Life Sciences & Biomedicine ,3-DIMENSIONAL RECONSTRUCTION ,030217 neurology & neurosurgery - Abstract
The present study aimed to evaluate the morphological characteristics of the sphenoid sinus (SS), and the impact of potential influencing factors on the morphometric features using CBCT imaging. CBCT scans of 148 patients, aged between 15 and 85 (32.88 ± 15.33) years were retrospectively evaluated. DICOM files from the CBCT scans were imported into semi-automatic software and the SS of each patient was assessed for the morphological characteristics including configuration, symmetry, extension, shape, septation, volume, and maximum diameter. Furthermore, potential influencing factors such as age, gender, side, and sinus condition were analysed. A significant association was observed between sinus extension and age. Septation was also found to be significantly associated with age, gender and sinus condition. Besides, sinus volume was significantly associated with gender and sinus condition. No significant influence of shape and side on the morphometric features was noticed. The average volume and diameter of the SS were 6576.92 ± 3748.12 mm3 and 30.48 ± 9.28 mm, respectively. In conclusion, the present findings indicate that age, gender and sinus condition have a significant impact on the morphometric characteristics of the SS. Mature sinuses exhibit a post-sellar extension pattern until middle age. In addition, males, and sinuses with healthy sinus condition have larger volumes compared to females and pathological sinuses. ispartof: ANATOMICAL SCIENCE INTERNATIONAL vol:96 issue:4 pages:544-555 ispartof: location:Japan status: published
- Published
- 2021
- Full Text
- View/download PDF
13. Modified Transpterygoid Approach to Sphenoid Meningoencephaloceles: A Shorter Run for a Longer Slide
- Author
-
Satyan B Sreenath, Aaron A. Cohen-Gadol, Troy D. Woodard, Raj Sindwani, Dennis M. Tang, Elisa A. Illing, Pablo F. Recinos, Jonathan Y. Ting, Varun R. Kshettry, and Pranay Soni
- Subjects
Adult ,Male ,medicine.medical_specialty ,Sphenoid Sinus ,Meningocele ,Surgical Flaps ,Encephalocele ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Sphenoid Bone ,medicine ,Humans ,030223 otorhinolaryngology ,Sinus (anatomy) ,Aged ,Retrospective Studies ,Intracranial pressure ,Pterygopalatine fossa ,Cerebrospinal Fluid Leak ,business.industry ,Endoscopy ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Lateral recess ,Dissection ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Female ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
OBJECTIVES Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks. STUDY DESIGN Multi-Institutional, Retrospective Case Series. METHODS Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated. RESULTS Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months. CONCLUSION The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2224-2230, 2021.
- Published
- 2021
- Full Text
- View/download PDF
14. Endoscopic transsphenoidal surgery reduces the need for re-operation compared to the microscopic approach in pituitary macroadenomas
- Author
-
Zvi Ram, Nir Shimony, Ben Shofty, Avraham Abergel, Nataly Popovits, and Rachel Grossman
- Subjects
Adenoma ,Adult ,Male ,Natural Orifice Endoscopic Surgery ,Reoperation ,medicine.medical_specialty ,Multivariate analysis ,Sphenoid Sinus ,Endoscopic endonasal surgery ,medicine.medical_treatment ,Tumor resection ,Nose ,Extent of resection ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Pituitary Neoplasms ,Aged ,Retrospective Studies ,Transsphenoidal surgery ,Surgical approach ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Surgery ,Endoscopy ,Oncology ,030220 oncology & carcinogenesis ,Female ,Pituitary surgery ,business ,030217 neurology & neurosurgery - Abstract
Introduction Pituitary surgery has shifted in recent years from microscopic surgery(MS) to endoscopic endonasal surgery (EES). However, the comparative long-term outcome of these surgical approaches, including the need for subsequent re-operation has never been reported. We present our experience in a high-volume referral center experienced in both endoscopic and microscopic approaches to compare the need for re-operation after initial resection of non-functioning pituitary macroadenomas using these surgical approaches. Methods 684 patients (398 with NF adenomas) underwent trans-sphenoidal pituitary surgery in our institution between 2006 and 2017. Complete follow-up (mean 72 months, minimum two years) was available in 87 newly diagnosed patients with non-functioning pituitary macroadenomas (NFPMA; 48-microscopic and 39-endoscopic). The EES approach has been used almost exclusively since 2012. The need for repeat operation for tumor resection during the follow-up period was assessed as the primary end-point of the study. Extracted data included various demographic and clinical parameters, radiographic findings as well as the extent of resection (EOR). Results The EOR was similar for both groups, with a trend towards better EOR in the EES group. The rate of surgical complications was also similar for both groups. There was a strong trend towards lower need for re-operation in the EES group compared to the MS group (12.8% vs. 29.2%, p = 0.056). In a multivariate analysis, only EOR and Knosp grade were independently associated with the need for re-operation surgery. Conclusion Our data indicate that EES in NFPMA tends to be associated with a lower need for re-operation compared to the MS approach, with a similar rate of EOR and complications.
- Published
- 2021
- Full Text
- View/download PDF
15. Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas
- Author
-
Eliza B Geer, Marie Roguski, Ankur R. Patel, Marc Cohen, Sasan Karimi, Rupa Juthani, Viviane Tabar, Katherine S. Panageas, Aimee Cowan, and Anne S. Reiner
- Subjects
Adenoma ,Adult ,Male ,Microsurgery ,medicine.medical_specialty ,Adolescent ,Sphenoid Sinus ,Endoscope ,Interventional magnetic resonance imaging ,Context (language use) ,Intraoperative MRI ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pituitary adenoma ,Monitoring, Intraoperative ,medicine ,Humans ,Pituitary Neoplasms ,Prospective Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Tumor Burden ,Treatment Outcome ,030220 oncology & carcinogenesis ,Diabetes insipidus ,Cavernous sinus ,Female ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
OBJECTIVE The utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches. METHODS Radiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated. RESULTS Of 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections. CONCLUSIONS These results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.
- Published
- 2021
- Full Text
- View/download PDF
16. The dimensions of the sphenoid sinuses: evaluation before the functional endoscopic sinus surgery
- Author
-
Joe Iwanaga, I. Zamojska, Małgorzata Mazur, Joanna Jaworek-Troć, Wojciech Przybycień, Jerzy A. Walocha, Robert Chrzan, and Michał P. Zarzecki
- Subjects
Adult ,Male ,Histology ,Sphenoid Sinus ,Adult population ,03 medical and health sciences ,Paranasal Sinuses ,medicine ,Humans ,SPHENOID SINUSES ,Transverse dimension ,Retrospective Studies ,0303 health sciences ,business.industry ,Anatomic Variation ,Functional endoscopic sinus surgery ,Sagittal plane ,Contrast medium ,medicine.anatomical_structure ,Paranasal sinuses ,030301 anatomy & morphology ,Female ,High incidence ,Anatomy ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Background: The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population. Materials and methods: The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool. Results: The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5–4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7–3.7 cm. Conclusions: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.
- Published
- 2021
- Full Text
- View/download PDF
17. Opening the Palatovaginal Canal to Maximize Anterior Sphenoidotomy in Endoscopic Endonasal Surgery
- Author
-
Rieko, Takuma Hara, Takashi Tamiya, Eiichi Ishikawa, Shuho Tanaka, Hidetaka Miyamoto, Daisuke Ogawa, Keisuke Miyake, Hiroyoshi Kino, and Hiroyoshi Akutsu
- Subjects
Adult ,Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Adolescent ,Sphenoid Sinus ,Endoscopic endonasal surgery ,Cerebrospinal Fluid Rhinorrhea ,Nose ,Central Nervous System Neoplasms ,Young Adult ,Postoperative Complications ,medicine ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Endoscopy ,Middle Aged ,Surgery ,Epistaxis ,medicine.anatomical_structure ,Otorhinolaryngology ,Palatovaginal canal ,Female ,Anatomic Landmarks ,business - Published
- 2021
- Full Text
- View/download PDF
18. Unusual case presentation of fungal ball infection causing diabetes insipidus and seizure disorder
- Author
-
Angela Guy, Kristi Saliaj, Marina Kokova, Anisa Cobo, Masum Rahman, Ali Guy, Azizjon Abdurakhimov, Azaliia Persits, Juna Musa, and Ina Kola
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,lcsh:R895-920 ,Case Report ,Fungal ball ,Aspergillosis ,Fungal rhinosinusitis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Vertigo ,otorhinolaryngologic diseases ,Medicine ,Radiology, Nuclear Medicine and imaging ,Sinus (anatomy) ,biology ,business.industry ,Chronic sinusitis ,Aspergillus spp ,medicine.disease ,biology.organism_classification ,Sphenoid sinus ,Dermatology ,medicine.anatomical_structure ,Chronic rhinosinusitis ,Diabetes insipidus ,Differential diagnosis ,Headaches ,medicine.symptom ,business ,Hyponatremia ,030217 neurology & neurosurgery - Abstract
Sphenoid sinus fungal ball (FB) is a noninvasive fungal infection affecting predominantly immunocompetent middle-aged female patients. Common clinical manifestations include headaches, postnasal drip, and nasal discharge. In this case report, we present a 56-year-old female with a 10-year history of occasional dizziness, vertigo, nystagmus, feeling disoriented and feeling her eyes moving rapidly. Complaints of restlessness, insomnia, anxiety, stress and anger were also present. Due to the nonspecific nature of her symptoms, a diagnosis of sphenoid sinus FB was overlooked. Definitive diagnosis was established after performing a nasal endoscopy and subsequent histopathological examination of the collected sinus tissues. The histopathology report disclosed Aspergillosis FB with chronic sinusitis. Due to the decade long delay in diagnosis and proper treatment, septal wall collapse occurred, with the patient developing diabetes insipidus with hyponatremia that led to a massive seizure and fall, resulting in multiple disc herniations. Surgical removal of the FA elicited a complete resolution of her symptoms and a full recovery. Although fungal rhinosinusitis is a well recognized spectrum of diseases by ENT specialists, through this case report we hope to draw attention to this particular pathological entity within fungal infections, while simultaneously underlining the broad spectrum of symptoms with which it may manifest and the importance of including FA infections when considering the differential diagnosis in patients with long-standing chronic sinusitis.
- Published
- 2021
19. Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach
- Author
-
Takeya Niibo, Toru Kobayashi, Seizi Takebayashi, Kouta Kuris, Katsumi Takizawa, Rina Kobayashi, Jurou Sakurai, Syusuke Gotou, Hiroyasu Koizumi, Ryousuke Tsuchiya, and Hiroyasu Kamiyama
- Subjects
Male ,Sphenoid Sinus ,medicine.medical_treatment ,Dura mater ,Sphenoparietal sinus ,Cranial Sinuses ,Neurosurgical Procedures ,Anterior clinoid process ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Sphenoid Bone ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Skull Base ,business.industry ,Intracranial Aneurysm ,General Medicine ,Clipping (medicine) ,Anatomy ,Middle Aged ,medicine.disease ,Cerebral Veins ,Cerebrovascular Disorders ,Skull ,Treatment Outcome ,medicine.anatomical_structure ,Superior orbital fissure ,030220 oncology & carcinogenesis ,cardiovascular system ,Female ,Internal carotid artery ,business ,Craniotomy ,030217 neurology & neurosurgery - Abstract
OBJECTIVEThe sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)–posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.METHODSThe authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.RESULTSWith the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.CONCLUSIONSThe SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.
- Published
- 2021
- Full Text
- View/download PDF
20. Anatomical Variants, Pneumatization Classification, and Volumetric Studies of the Sphenoid Sinus With High-Resolution Computed Tomography
- Author
-
Meng Yu, Fang Guo, Yujia Yan, Jiayu Liu, and Ying Huang
- Subjects
High-resolution computed tomography ,Sphenoid Sinus ,medicine.diagnostic_test ,business.industry ,Significant difference ,Anatomic Variation ,Computed tomography ,General Medicine ,Anatomy ,medicine.anatomical_structure ,Otorhinolaryngology ,Clivus ,Sphenoid Bone ,medicine ,Humans ,SPHENOID SINUSES ,Surgery ,Tomography, X-Ray Computed ,business ,Sinus (anatomy) ,Aged ,Retrospective Studies - Abstract
Aimed to explore the correlation between the volume of the sphenoid sinuses (SS) and sex, age, pneumatization and its anatomical variant types.Retrospectively evaluated high-resolution computed tomography images of 170 individuals; were studied by ITK-SNAP software to measure the volume of SS.The average volume of SS was a significant difference between the gender, the volume of SS in the elderly group (≥65 years old) showed a downward trend. The volume of the SS in the variants of the anterior clinoid processes, pterygoid processes, greater wings, and clivus were significantly higher than in the nonvariants (P 0.05). With the expansion of pneumatization, the optic nerve (CNII) type 3-4, the internal carotid artery (ICA) type 2-3 and the septal insertion on the ICA have a larger volume, while the occurrence of septal insertion on only the CNII was not correlated with the volume (P 0.05).The volume of SS is closely related to age, sex, the type of pneumatization and anatomical variation. High-resolution computed tomography can facilitate a precise study of anatomical variations and adjacent structures and help ensure the safety of an operation.
- Published
- 2021
- Full Text
- View/download PDF
21. Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature
- Author
-
Sylvie Nadeau and Noémie Villemure-Poliquin
- Subjects
medicine.medical_specialty ,business.industry ,Endoscopic sinus surgery ,Sphenoidectomy ,Sphenoid sinus ,medicine.disease ,Surgery ,03 medical and health sciences ,Ostium ,0302 clinical medicine ,Transnasal sphenoidectomy ,030220 oncology & carcinogenesis ,Chart review ,Medicine ,Case Series ,030211 gastroenterology & hepatology ,Sphenoid Sinusitis ,Mucocele ,Sinusitis ,business ,Surgical treatment ,Complication ,Sphenoidal sinusitis - Abstract
Highlights • Isolated sphenoid opacification is a rare pathology that is increasingly being described and it represents 1–2% of sinus infections. • The most frequent symptom associated with isolated sphenoid sinusitis is intractable headache. • Isolated sphenoid sinusitis is usually treated surgically and endoscopic transnasal sphenoidectomy is the preferred surgical technique. • Highly inflammatory diseases such as fungal infections may be associated with an increased risk of re-ossification of the sphenoid ostium following sphenoidectomy., Introduction Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature. Methods We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis. Results 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 103% (3/29) and the mean recurrence time was 15 (9–26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25–68) for the 29 patients analyzed in our study. Conclusion Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.
- Published
- 2021
- Full Text
- View/download PDF
22. Arrested Pneumatization of the Sphenoid Sinus in the Skull Base
- Author
-
Seong Hyun Park and Jeong-Hyun Hwang
- Subjects
medicine.medical_specialty ,Sphenoid bone ,Case Report ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Clivus ,Diagnosis ,medicine ,Bone ,Sinus (anatomy) ,General Environmental Science ,business.industry ,Skull ,Soft tissue ,Anatomy ,medicine.disease ,Sphenoid sinus ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,General Earth and Planetary Sciences ,Neurosurgery ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Calcification - Abstract
We report 2 cases of arrested pneumatization of the sphenoid sinus, a normal variant commonly misdiagnosed as a serious condition of the skull base. A 65-year-old man visited a local clinic for regular checkups. Brain CT showed a non-expansile lesion of the soft tissue with a well-defined sclerotic margin in the clivus but without destruction or mass effect on the surrounding bony structures. Subsequent brain MRI revealed that the lesion within the clivus was a high-signal lesion on the T2-weighted image, containing a low-signal round mass seen on a high-intensity signal on the T1-weighted image without contrast enhancement. Thus, the lesion was considered to contain internal fat. A 70-year-old woman diagnosed with a tumor in the greater sphenoid bone visited our hospital. Her brain CT revealed a non-expansile lesion of mixed density and a well-demarcated lesion and internal curvilinear calcification in the left greater wing of the sphenoid bone. The margin was osteosclerotic and the adjacent bony structure was intact. Her brain MRI showed that the lesion within the greater sphenoid bone had multiple low-signal lesions within a high-signal lesion on the T2-weighted image, suggesting internal fat contents. The lesions were diagnosed as arrested pneumatization of the sphenoid sinus and no further examination or treatment was performed. Arrested pneumatization of the sphenoid sinus should be considered in the presence of non-expansile lesion with an osteosclerotic boundary and internal fat component in the skull base.
- Published
- 2021
23. Prognostic Factors of Acromegalic Patients with Growth Hormone–Secreting Pituitary Adenoma After Transsphenoidal Surgery
- Author
-
Chin Taweesomboonyat and Thakul Oearsakul
- Subjects
Male ,Microsurgery ,Multivariate analysis ,Growth hormone-secreting pituitary adenoma ,medicine.medical_treatment ,Disease ,Logistic regression ,Gastroenterology ,Neurosurgical Procedures ,0302 clinical medicine ,Treatment Failure ,Insulin-Like Growth Factor I ,Remission Induction ,Middle Aged ,Prognosis ,Tumor Burden ,Treatment Outcome ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,Adult ,Reoperation ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,Sphenoid Sinus ,Adenoma ,03 medical and health sciences ,Hormone Antagonists ,Sex Factors ,Pituitary adenoma ,Internal medicine ,Acromegaly ,medicine ,Humans ,Neoplasm Invasiveness ,Pituitary Neoplasms ,Bromocriptine ,Retrospective Studies ,Transsphenoidal surgery ,business.industry ,medicine.disease ,Logistic Models ,Neuroendoscopy ,Radiotherapy, Adjuvant ,Surgery ,Neurology (clinical) ,Growth Hormone-Secreting Pituitary Adenoma ,Neoplasm Grading ,business ,030217 neurology & neurosurgery - Abstract
Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. Transsphenoidal surgery is the first-line treatment of this adenoma. This study aimed to identify factors associated with remission outcome in patients with GH-secreting pituitary adenomas following transsphenoidal surgery.Patients with GH-secreting pituitary adenomas who underwent transsphenoidal surgery for tumor removal at Songklanagarind Hospital between January 2003 and December 2019 were retrospectively reviewed. The primary outcome was the remission of disease at the last follow-up using 2000 and 2010 consensus criteria. Using logistic regression analysis, various factors were analyzed for association with disease remission outcome.This study included 51 patients. The remission rate of GH-secreting pituitary microadenomas and macroadenomas following transsphenoidal surgery were 100% and 43.75%, respectively. Multivariate analysis showed that preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were significantly associated with nonremission outcome (P0.001 and P = 0.012, respectively). Patients with both of these factors had poor outcomes and never achieved remission after treatment, while patients with neither of these factors had high remission rates (87.5%) following surgery. Four of 6 (66.7%) patients who underwent repeat surgery gained remission.Preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were important prognostic factors that determined remission outcome after treatment. Patients who have both of these poor prognostic factors should be aggressively treated with surgery, medication, and probably radiation to optimally control the disease.
- Published
- 2021
- Full Text
- View/download PDF
24. Incidental finding of metastatic malignancy involving the sphenoid sinus on a cone-beam computed tomographic scan: A case report
- Author
-
Niloufar Amintavakoli
- Subjects
Paranasal Sinus Neoplasm ,Nasal cavity ,medicine.medical_specialty ,Cone beam computed tomography ,Sphenoid Sinus ,Radiography ,Case Report ,Malignancy ,urologic and male genital diseases ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Oral and maxillofacial pathology ,medicine ,Radiography, Dental ,Radiology, Nuclear Medicine and imaging ,General Dentistry ,Sinus (anatomy) ,Incidental Findings ,Radiological and Ultrasound Technology ,business.industry ,Soft tissue ,030206 dentistry ,respiratory system ,Cone-Beam Computed Tomography ,medicine.disease ,medicine.anatomical_structure ,Radiology ,business ,Paranasal Sinus Neoplasms - Abstract
The increased use of cone-beam computed tomographic (CBCT) scans has made it increasingly necessary to evaluate incidental findings on CBCT scans. This report describes the case of a 66-year-old female patient who presented to the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at the College of Dentistry of the author's institution and underwent a CBCT scan for maxillary alveolar process implant planning. Upon evaluation of the CBCT scan, a radiopaque (soft tissue attenuation) mass in the left superior aspect of the nasal cavity and left locule of the sphenoid sinus with opacification of the left locule of the sphenoid sinus was incidentally noted. These radiographic findings were suggestive of a space-occupying mass with a high possibility of malignancy. A further medical evaluation confirmed renal cell cancer metastasis to the sphenoid sinus. This study shows the significance of reviewing the entire CBCT scan for incidental findings.
- Published
- 2021
25. Supplementation With Dexmedetomidine for Transsphenoidal Resection of Pituitary Adenoma: A Meta-Analysis of Randomized Controlled Trials
- Author
-
Caibin Gao, Wenqing Liu, Chunhong Liu, Jianbo Shen, Xiaoxia Du, Tongshan Ma, Zhongtao Liu, and Xingguo Xu
- Subjects
Adenoma ,Mean arterial pressure ,Sphenoid Sinus ,Nausea ,Cochrane Library ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pituitary adenoma ,medicine ,Humans ,Pituitary Neoplasms ,Pharmacology (medical) ,Dexmedetomidine ,Randomized Controlled Trials as Topic ,Pharmacology ,Pain, Postoperative ,business.industry ,Odds ratio ,Analgesics, Non-Narcotic ,medicine.disease ,030227 psychiatry ,Fentanyl ,Anesthesia ,Vomiting ,Drug Therapy, Combination ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
INTRODUCTION The effect of dexmedetomidine supplementation on hemodynamic stability for transsphenoidal resection of pituitary adenoma remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexmedetomidine supplementation on hemodynamic stability for transsphenoidal resection of pituitary adenoma. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2020 for randomized controlled trials assessing the effect of dexmedetomidine supplementation on transsphenoidal resection of pituitary adenoma. RESULTS Four randomized controlled trials involving 160 patients were included in the meta-analysis. Overall, compared with the control group for transsphenoidal resection of pituitary adenoma, dexmedetomidine supplementation resulted in significantly reduced mean arterial pressure at 30 minutes [mean difference (MD), -26.62; 95% confidence interval (CI), -36.71 to -16.53; P < 0.00001], heart rate at 30 minutes (MD, -16.50; 95% CI, -32.48 to -0.53; P = 0.04), blood loss (MD, -112.57; 95% CI, -165.12 to -60.01; P < 0.0001), and fentanyl (MD, -154.13; 95% CI, -303.97 to -4.29; P = 0.04), but demonstrated similar incidence of nausea and vomiting (odds ratio, 0.37; 95% CI, 0.13-1.03; P = 0.06), and hypotension (odds ratio, 2.11; 95% CI, 0.49-9.22; P = 0.32). CONCLUSIONS Dexmedetomidine supplementation was effective in improving hemodynamic stability for transsphenoidal resection of pituitary adenoma.
- Published
- 2021
- Full Text
- View/download PDF
26. Spontaneous Temporal Lobe Encephalocele Within the Sphenoid Sinus
- Author
-
Abdelhafidh Sliman, Nadhir Karmeni, Sawsen Dhambri, Mohammed Dhaha, and Jalel Kallel
- Subjects
Leak ,medicine.medical_specialty ,sphenoid sinus ,lcsh:Surgery ,spontaneous encephalocele ,Middle cranial fossa ,Encephalocele ,Temporal lobe ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,medicine ,030223 otorhinolaryngology ,Craniofacial surgery ,Sinus (anatomy) ,csf leak ,business.industry ,lcsh:RD1-811 ,medicine.disease ,medicine.anatomical_structure ,transcranial approach ,Surgery ,Radiology ,business ,Meningitis ,030217 neurology & neurosurgery - Abstract
Encephaloceles are herniation of cranial content arising from a skull defect. Encephaloceles of the lateral wall of the sphenoid sinus (ELWSS) are uncommon events. In most cases, these cranial hernias are secondary to trauma and craniofacial surgery. Spontaneous forms are evenrarer and not well understood. The most adopted hypothesis is a persisting Sternberg’s canal, an embryonic remnant connecting the middle cranial fossa and the nasopharynx. ELWSS are usually revealed by cerebrospinal fluid (CSF) leak. Diagnosis of this disease necessitates quick management due to the potential of lethal complications such as meningitis. We report the case of a spontaneous ELWSS in a 53-year-old woman revealed by CSF leak which was successfully managed with a conventional transcranial approach. We focus on the clinical aspect and pathogenesis of the disease, and discuss the main possible surgical approaches. Keywords: Spontaneous encephalocele, Sphenoid sinus, CSF leak, Transcranial approach
- Published
- 2021
27. Orbital apex anatomy: relationship between the optic foramen and anterior face of sphenoid sinus — a radiological study
- Author
-
Jaskirat Aujla, David S. Curragh, Sandy Patel, and Dinesh Selva
- Subjects
Adult ,Sphenoid Sinus ,genetic structures ,Orbital decompression ,Article ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Sphenoid Bone ,medicine ,Foramen ,Humans ,Sinus (anatomy) ,Medial orbital wall ,Adult patients ,business.industry ,Anatomy ,eye diseases ,Ophthalmology ,medicine.anatomical_structure ,Radiological weapon ,030221 ophthalmology & optometry ,sense organs ,Tomography, X-Ray Computed ,business ,Orbit ,030217 neurology & neurosurgery ,Orbital apex - Abstract
Background/objectives This study aims to identify radiologically the position of the optic foramen in relation to the anterior face of the sphenoid sinus, to aid surgeons in their planning for orbital decompression. Methods CT scans of 100 orbits from 50 adult patients without any abnormality were assessed. Primary outcome measures included: position and measurement of the distance from the optic foramen to the anterior face of the sphenoid sinus. Secondary outcomes included: medial orbital wall length, distance from the optic foramen and the anterior face of the sphenoid sinus to the carotid prominence in the sphenoid sinus, and the thickness of bone anterior to the optic foramen. Results The mean location of the optic foramen was just posterior to the position of the anterior face of sphenoid sinus, with an average distance of +0.4 +/- 3.5 mm. In 54% of orbits the optic foramen was positioned posterior to the anterior face of the sphenoid sinus. The finding was symmetrical in 80% of patients. Conclusions Our study identifies that the optic foramen lies posterior to the anterior face of sphenoid sinus in approximately half of cases. The position may be asymmetric in 20% of individuals.
- Published
- 2020
- Full Text
- View/download PDF
28. Pneumosinus dilatans of the sphenoid and visual loss: when should the optic nerve be decompressed?
- Author
-
Maxime Bretonnier, Maïa Proisy, Gilles Danassegarane, Laurent Riffaud, Julien Tinois, CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
medicine.medical_specialty ,Adolescent ,Sphenoid Sinus ,genetic structures ,Vision ,Vision Disorders ,Sphenoid bone ,Blindness ,Anterior clinoid process ,03 medical and health sciences ,Optic canal ,0302 clinical medicine ,Atrophy ,Sphenoid Bone ,medicine ,Humans ,Pneumosinus dilatans ,030223 otorhinolaryngology ,Sinus (anatomy) ,business.industry ,Optic Nerve ,General Medicine ,medicine.disease ,eye diseases ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Optic nerve ,Surgery ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,sense organs ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Orbit (anatomy) - Abstract
International audience; Pneumosinus dilatans of the sphenoid sinus is a rare disorder which can be responsible for visual impairment and blindness. We present the case of an adolescent female who experienced progressive decrease in right-eye vision over 2 years. CT scan of the head showed an extensive pneumatization of the sphenoid bone extending to the lesser wing of the sphenoid and to the anterior clinoid process on the right side. MRI revealed right nerve atrophy in the optic canal and in the posterior part of the orbit. A surgical decompression of the right optic canal was performed via an intradural fronto-pterional approach. Postoperatively, her vision worsened, and at 3 years the patient was able to count fingers at 2.5 m. Our case and literature review of symptomatic sphenoidal pneumosinus dilatans confirmed that visual prognosis in such cases depended on the preoperative visual status. Early surgical decompression should be proposed whenever possible, before signs of severe visual disorders and optic atrophy.
- Published
- 2020
- Full Text
- View/download PDF
29. A case of cavernous carotid aneurysm diagnosed when diplopia developed after endoscopic sinus surgery
- Author
-
Eri Mori, N. Otori, M. Tei, and Hiromi Kojima
- Subjects
Diplopia ,medicine.medical_specialty ,nasal surgical procedures ,business.industry ,Chronic rhinosinusitis ,sinusitis ,craniocerebral trauma ,sphenoid sinus ,General Medicine ,Case presentation ,lcsh:Otorhinolaryngology ,medicine.disease ,lcsh:RF1-547 ,Carotid aneurysm ,Surgery ,Conservative treatment ,Endoscopic sinus surgery ,Aneurysm ,medicine.anatomical_structure ,cardiovascular system ,medicine ,cardiovascular diseases ,medicine.symptom ,business ,Sinus (anatomy) - Abstract
Background: Visual complications of endoscopic sinus surgery usually occur during or immediately after the surgery. We report a case of cavernous carotid aneurysm which developed and gradually worsened after endoscopic sinus surgery was performed. Case presentation: A 63-year-old woman with chronic rhinosinusitis resistant to conservative treatment underwent endoscopic sinus surgery. Despite the surgery being successful and without complications, diplopia developed 2 weeks later. Intracranial ima- ging revealed a giant cavernous carotid aneurysm as a likely cause of the diplopia. The patient underwent endovascular stenting treatment, and the diplopia was consequently reduced. Conclusions: We experienced a rare case of cavernous carotid aneurysm which started to develop 2 weeks after endoscopic sinus surgery. Possible causes of the aneurysm in this patient are an indirect effect of surgery, such as perioperative hypertension, and bacterial sinusitis.
- Published
- 2020
- Full Text
- View/download PDF
30. A rare cause of bilateral exophthalmos: about one case with a sphenoid mucocele
- Author
-
N. Pilor, M. Ndiaye, M.S. Diouf, A.D. Faye, A. Tall, C. Ndiaye, R. Deguenonvo, E.S. Diom, I.C. Ndiaye, and R. Diouf
- Subjects
medicine.medical_specialty ,sphenoidal mucocele ,Exophthalmos ,marsupialization ,business.industry ,sinus ct ,sphenoid sinus ,General Medicine ,medicine.disease ,lcsh:Otorhinolaryngology ,lcsh:RF1-547 ,sphenoidotomy ,medicine ,Radiology ,Mucocele ,medicine.symptom ,business - Abstract
Background: Mucocele is a benign cystic pseudo-tumor that develops within the sinus cavities. The most frequent locations are frontal and frontoethmoidal. The sphenoidal forms are rare. We report a case of sphenoidal mucocele revealed by bilateral exophthalmos. Methods and results: We report the case of a 14 year old male patient, without any particular pathological history, referred by his ophthalmologist for bilateral nasal obstruction, bilateral exophthalmos and visual acuity decrease evolving since one year. The ENT examination found a large, renitrant mass, filling the entire right nasal cavity. This mass pushed the nasal septum to the left. The CT scan showed a large sphenoidal, hypodense mass evoking a mucocele. The patient underwent endonasal marsupialization by endoscopic guidance. Conclusions: Sphenoidal mucocele is a rare cause of bilateral exophthalmos. The diagnosis can be misplaced when the signs are overt extra-sinus. Hence the interest of CT in order to eliminate other differential dignostics.
- Published
- 2020
31. Two Cases of Acute Isolated Sphenoid Sinusitis in Children
- Author
-
Yung Jin Jeon, Sangwook Park, and Sangyoon Lee
- Subjects
medicine.medical_specialty ,business.industry ,sinusitis ,lcsh:R ,sphenoid sinus ,lcsh:Medicine ,lcsh:Otorhinolaryngology ,Dermatology ,lcsh:RF1-547 ,03 medical and health sciences ,0302 clinical medicine ,children ,030220 oncology & carcinogenesis ,medicine ,Sphenoid Sinusitis ,030223 otorhinolaryngology ,business ,headache ,endoscopic sinus surgery - Abstract
Acute isolated sphenoid sinusitis is a rare disease, and accounts for less than 3% of all sinusitis, especially in young children. Delayed diagnosis or misdiagnosis can occur frequently due to atypical clinical presentations. This can lead to serious complications because of the involvement of anatomically related intracranial structures. Therefore, nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools to confirm the diagnosis. We report two cases of a previously healthy 6-year-old girl and a 13-year-old boy, whose chief complaints were uncontrolled headache and high fever over 38°C. Physical examination and initial laboratory test results of blood, urine, and cerebrospinal fluid were normal. The diagnosis was made after a brain MRI revealed isolated sphenoid sinusitis. The girl was treated with third generation cephalosporins intravenously. The boy, however, had to undergo an emergent endoscopic sinus surgery as his headache and eyeball-pain symptoms did not resolve by medical treatment alone. Both cases had good outcomes, without neurological sequelae.
- Published
- 2020
32. A Radio-Anatomic Profile of the Sphenoid Sinus, Vidian Canal and Foramen Rotundum Structured
- Author
-
Jithendra N, K R Vijay Kumar, H C Ramanna, and Samarth S. Gowda
- Subjects
business.industry ,lcsh:R5-130.5 ,sphenoid sinus ,Anatomy ,medicine.anatomical_structure ,vidian canal ,medicine ,otorhinolaryngologic diseases ,business ,foramen rotundum ,Foramen rotundum ,Sinus (anatomy) ,lcsh:General works ,lateral pterygoid plate - Abstract
BACKGROUND One of the most vital structures in the anterior skull base surgeries is sphenoid sinus. Sellar, parasellar, suprasellar and clival lesions can be easily accessed using sphenoid sinus and is one of the most variable of all the paranasal sinuses in terms of its surrounding anatomical relationships. It also serves as a natural route for surgical entry to the middle cranial fossa and the cave of Meckel. Further, foramen of Rotundum and the canal of Vidian serve as vital gateways to important neurovascular structures, and their close proximity to the sphenoid sinus makes it necessary for the operating surgeon to have a better understanding of this anatomical ’Holy trinity’. By shedding light on this complex anatomical relationship through the course of our study, we hope to be of better assistance to the operating surgeons. METHODS 100 consecutive CT scans of the paranasal sinuses performed for any cause, were reviewed retrospectively to look for the sphenoid sinus and its anatomical relationship to the foramen rotundum and vidian canal. All the computed tomography scans were performed using Philips Ingenuity 128 slice CT scanner. 3 mm slice contiguous images were taken, and 1 mm slice reconstruction was performed. Images were reviewed in three orthogonal planes. RESULTS Based on the study, the most common type of foramen rotundum was ’Type IIB’ and the most common position of foramen rotundum in relation to sphenoid sinus based on lateral pterygoid plate was found to be the ‘online’ type. The most common variation in the Vidian canal anatomy was found to be the ‘Type II’ canal. No association was found between types of foramen rotundum and vidian canals with position of foramen rotundum. CONCLUSIONS Knowledge of the complex anatomical relationship of sphenoid sinus is important for skull base surgeries. Results of the study help us to understand the most common anatomical variations, thus aiding in better surgical outcomes.
- Published
- 2020
33. Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery
- Author
-
Ala'a Alhowary, Majid Bani-Ata, Abdelwahab J Aleshawi, Firas Alzoubi, and Bashar Abuzayed
- Subjects
Adult ,medicine.medical_specialty ,Sphenoid Sinus ,Endoscopic endonasal surgery ,Transsphenoidal approach ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,03 medical and health sciences ,0302 clinical medicine ,Pituitary adenoma ,Adhesives ,medicine ,otorhinolaryngologic diseases ,Humans ,Pituitary Neoplasms ,Acrylic glue ,Sinusitis ,GLUE ,Sinus (anatomy) ,Nose ,Transsphenoidal surgery ,Cerebrospinal Fluid Leak ,Cerebrospinal fluid leak ,business.industry ,Endoscopy ,General Medicine ,lcsh:RD1-811 ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Chronic rhinosinusitis ,030228 respiratory system ,Female ,business ,030217 neurology & neurosurgery - Abstract
Background To reduce the risk of cerebrospinal fluid leak, clinicians utilize a filling material placed in the sella followed by floor reconstruction with various materials, including glue sealing. Cyano-acrylic glue Glubran®2 glue is commercially available and is generally used as embolizing agent and for the prevention of cerebrospinal fluid leakage. Case Description A 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran®2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and para-sphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge. Conclusion To the best of our knowledge, this is the first case reporting of acrylic glue (Glubran®2)-related sinusitis. Surgeon should be aware about similar side effects for the glue material that would complicate the surgery.
- Published
- 2020
- Full Text
- View/download PDF
34. Sphenoid sinus aspergilloma clinically mimicking as malignancy—a case report
- Author
-
Ruchi Gupta, Neetu Sinha, Subhash Kumar, and Abhishek Anand
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,lcsh:R895-920 ,Malignancy ,Bone remodeling ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Sinus (anatomy) ,Sphenoidal sinus ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Sphenoid sinus ,Hyperintensity ,medicine.anatomical_structure ,Fungal ,Aspergillus ,Pituitary ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Aspergilloma ,CT ,MRI - Abstract
Background Fungal sphenoid sinusitis mimicking as malignant tumor and invading the pituitary fossa is an uncommon entity. This report aims to highlight radiological salient features to help differentiate fungal lesion from malignant tumor in sphenoidal sinus mass lesions. Case presentation We intend to report a case of middle-aged female who presented with gradual progressive diminution of vision since 3 years complicated with acute attack of unilateral headache and numbness. Computed tomography (CT) showed hyperdense lesion involving the sphenoid sinus extending into pituitary fossa and bilateral cavernous sinuses with smooth bony remodeling. Lesion appeared hypointense on T2-weighted and hyperintense on T1-weighted images on magnetic resonance imaging (MRI). Surgical excision of the lesion was done and pathological examination showed fungal hyphae and aspergillus fumigatus species on culture after 2 weeks of incubation. Post-operative CT revealed empty sinuses with surrounding bone remodeling. Conclusion Combination of T1 hyperintensity, T2 hypointensity, and hyperdense sinus is a strong predictor of fungal mass lesion involving sphenoid sinus.
- Published
- 2020
- Full Text
- View/download PDF
35. Sphenoid sinus agenesis and sella turcica hypoplasia: very rare cases of two brothers with Hamamy syndrome
- Author
-
Büşra Arikan, Numan Dedeoğlu, Oğuzhan Altun, and Suayip Burak Duman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sphenoid Sinus ,Telecanthus ,HAMAMY SYNDROME ,Pathology and Forensic Medicine ,Consanguinity ,03 medical and health sciences ,Intellectual Disability ,Myopia ,medicine ,Humans ,Sella Turcica ,Radiology, Nuclear Medicine and imaging ,Genetic Testing ,Craniofacial ,Sinus (anatomy) ,0303 health sciences ,Hypertelorism ,business.industry ,Siblings ,Anatomy ,Cone-Beam Computed Tomography ,medicine.disease ,Hypoplasia ,Pedigree ,medicine.anatomical_structure ,Sella turcica ,030301 anatomy & morphology ,Agenesis ,Orthopedic surgery ,Surgery ,Bone Diseases ,business - Abstract
Hamamy syndrome (HS) is an autosomal recessive syndrome with a genetic origin that is very rarely observed. The syndrome with craniofacial dysmorphisms, including midface prominence, severe telecanthus, sparse lateral eyebrows, protruding ears, fronto-nasal abnormalities, lacrimal-salivary apparatus agenesis, thin upper vermillion border, myopia, mental retardation, sensorineural hearing impairment, congenital heart anomalies with intraventricular conduction delay, hypochromic microcytic anaemia and skeletal abnormalities of the long bones with recurrent fractures. In this paper, we report a case of two brothers diagnosed with HS at the ages of 25 and 18 years, visited out clinic at different times due to dental reasons. In the radiological examinations, it was observed that both brothers have sphenoid sinuses agenesia, and their sella turcica were smaller than normal. HS may be observed very rarely, and it should be kept in mind that, in addition to various symptoms, it may also cause sphenoid sinus agenesis and sella turcica hypoplasia as shown for the first time in this case report.
- Published
- 2020
- Full Text
- View/download PDF
36. Volumetric Investigation of Sphenoid Sinus in an Elderly Population
- Author
-
Axel Wolf, Alen Palackic, Alexandros Andrianakis, Clemens Holzmeister, Peter Kiss, Ulrike Pilsl, Peter Valentin Tomazic, and Ulrich Moser
- Subjects
Male ,Sphenoid Sinus ,Conchal sinus ,Population ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Elderly population ,Sphenoid Bone ,medicine ,Humans ,SPHENOID SINUSES ,030223 otorhinolaryngology ,education ,Sinus (anatomy) ,Aged ,Aged, 80 and over ,Skull Base ,Human cadaver ,education.field_of_study ,business.industry ,Sphenoid body ,Anatomic Variation ,030206 dentistry ,General Medicine ,Anatomy ,medicine.anatomical_structure ,Otorhinolaryngology ,Female ,Surgery ,business - Abstract
The aims of this study were to determine the sphenoid sinus volume in an Austrian population, evaluate the relationship between volume and different types of pneumatization and investigate possible age-related sphenoid sinus volume degeneration in the elderly. A total of 50 human cadaver including 25 male and 25 female samples (=100 sphenoid sinuses, age range 65-100, mean age 84.52 ± 9.50) were selected to obtain volume and anatomical variants of pneumatization by using sphenoid sinus casts, made of quadrofunctional hydrophilic addition reaction silicone. The mean sphenoid sinus volume was 4.79 ± 2.39 cm. Males showed statistically significant larger sinus volumes than females (P = 0.048). The volume differed statistically significant for the different types of pneumatization (P
- Published
- 2020
- Full Text
- View/download PDF
37. Organized Hematoma of the Sphenoid Sinus With Acute Blindness: Insight Into Pathogenesis of Disease
- Author
-
Yaron A. Moshel, Melody Paz, Ronald P. Benitez, Giant C. Lin, Jeffrey LeBenger, and Jade Wells Porrmann
- Subjects
Male ,medicine.medical_specialty ,Sphenoid Sinus ,Maxillary sinus ,Disease ,Blindness ,Diagnosis, Differential ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Paranasal Sinus Diseases ,Humans ,Medicine ,Acute blindness ,030223 otorhinolaryngology ,Sinus (anatomy) ,Aged ,Aged, 80 and over ,business.industry ,Fibrous dysplasia ,Chronic sinusitis ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Epistaxis ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail.
- Published
- 2020
- Full Text
- View/download PDF
38. Small Cell Neuroendocrine Carcinoma of Paranasal Sinuses: Radiologic Features in 14 Cases
- Author
-
Zhengyue Wang, Siqi Luo, Naier Lin, Fang Zhang, Yan Sha, Meng Qi, and Yucheng Pan
- Subjects
Adult ,Male ,Nasal cavity ,medicine.medical_specialty ,Sphenoid Sinus ,Maxillary sinus ,Sensitivity and Specificity ,small cell neuroendocrine carcinoma ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,paranasal sinus ,Ethmoid Sinus ,medicine ,Humans ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,Carcinoma, Small Cell ,Staging system ,Sinus (anatomy) ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,computed tomography ,Magnetic resonance imaging ,nasal cavity ,Middle Aged ,Neuroimaging:Head and Neck ,Magnetic Resonance Imaging ,Carcinoma, Neuroendocrine ,Paranasal sinuses ,medicine.anatomical_structure ,Small cell neuroendocrine carcinoma ,Preoperative Period ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,neoplasm ,Paranasal Sinus Neoplasms ,030217 neurology & neurosurgery - Abstract
Purpose The purpose of this study was to explore the characteristic computed tomography (CT) and magnetic resonance (MR) features of small cell neuroendocrine carcinoma (SNEC) of paranasal sinuses. Materials and methods Computed tomography (n = 8) and MR (n = 14) images and clinical findings from 14 patients with SNEC of paranasal sinuses were retrospectively reviewed. Results Eight lesions were located in the ethmoidal sinus, 4 in the maxillary sinus, and 2 in the sphenoid sinus. Small cell neuroendocrine carcinoma of the sphenoid sinus showed bilateral asymmetry patterns. On CT images, bony changes were visible in all 8 cases. On MR, 4 cases contained hemorrhage, and 10 cases contained cystic or necrotic areas. All cases demonstrated marked heterogeneous enhancement, with half showing a "cribriform-like" or "geographic" appearance. The nasal cavity was the most common site invaded by SNEC of paranasal sinuses, followed by the orbits. A time-signal intensity curve examination showed a washout-type pattern in all but 1 case. The mean ± SD apparent diffusion coefficient value was 0.702 ± 0.112 (×10 mm/s). According to the Dulguerov staging system, 9 tumors were staged as N0 (1 T1, 1 T2, 5 T3, and 2 T4). The recurrence rate was 64.3%. Conclusions Some characteristics of radiological findings can provide important clues for preoperative diagnosis.
- Published
- 2020
- Full Text
- View/download PDF
39. Sphenoid sinus mucocele as an unusual differential diagnosis in diving injuries
- Author
-
Bengusu Mirasoglu, Şamil Aktaş, and Seren Kirmizi
- Subjects
Male ,medicine.medical_specialty ,Sphenoid Sinus ,Hearing loss ,Nausea ,Diving ,Mucocele ,Case Report ,Diagnosis, Differential ,Decompression sickness ,Vertigo ,otorhinolaryngologic diseases ,medicine ,Humans ,Sinus (anatomy) ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,biology.organism_classification ,Surgery ,medicine.anatomical_structure ,Cavernous sinus ,medicine.symptom ,Differential diagnosis ,business ,human activities - Abstract
Sphenoid sinus mucocele is a rare cystic lesion. It grows gradually and causes visual disturbances, ocular motility abnormalities and headache due to cavernous sinus compression. Sudden change in sinus cavity volume by a barotrauma may compress a mucocele and precipitate symptoms that may easily be confused with decompression sickness. A diver suffering from vertigo, nausea, blurry vision and hearing loss following uneventful dives is presented in this report. He underwent hyperbaric oxygen treatment for inner ear decompression sickness but later was diagnosed as sphenoid sinus mucocele. A high index of suspicion is necessary to capture rare conditions like mucocele in the differential diagnosis for divers with symptoms suggesting vestibulocochlear origin. To our knowledge, only one sphenoid sinus mucocele case presenting as a diving injury has been previously reported.
- Published
- 2020
- Full Text
- View/download PDF
40. Transsphenoidal approach in children with partially or minimally developed sphenoid sinus
- Author
-
Rudolf Fahlbusch, Mario Giordano, Massimo Gallieni, and Ismail Zaed
- Subjects
Adult ,medicine.medical_specialty ,Neuronavigation ,Sphenoid Sinus ,Interventional magnetic resonance imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Fluoroscopy ,Pituitary Neoplasms ,Child ,Sinus (anatomy) ,Skull Base ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Perioperative ,Magnetic Resonance Imaging ,Skull ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,Neurosurgery ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
The transsphenoidal approach is guided by a few fundamental anatomic landmarks. Pneumatization of the SS is variable, and this plays a key role in accessing the sella floor and other skull base structures. It may be absent or minimally present in both adult and, often, pediatric population, making surgical approach more difficult than usual. We aim to demonstrate that also in the more difficult cases, with a minimal level of pneumatization, the transsphenoidal approach is still possible especially with the support of neuronavigation and intraoperative magnetic resonance imaging (iMRI). We present our experience accumulated after the treatment of 6 children with minimally pneumatized sphenoid sinus describing the workflow to access the sella floor. No perioperative complications due to the surgical approach were observed, and no cases of mortality were reported. After the surgery, the visual field deficit improved in 1 patient and remained stable in three patients. No postoperative new neurologic deficits were found. No cases of cerebrospinal fluid (CSF) leak were observed. The transsphenoidal approach can be safely used even in cases of minimally or even absent pneumatization of SS as in young children. In order to have a safe approach in such patients, the use of tools, such as navigation system and iMRI, is recommended. Furthermore, the iMRI allows to avoid exposure to radiation as in case of fluoroscopy.
- Published
- 2020
- Full Text
- View/download PDF
41. Prevalence of accessory septations of sphenoid sinus in pediatric population: Applications to endoscopic sinus surgery
- Author
-
Claudia Dolci, Michaela Cellina, Stefano Gibelli, Giancarlo Oliva, Giovanni Termine, Chiarella Sforza, and Daniele Gibelli
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Histology ,Adolescent ,Sphenoid Sinus ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Sphenoid Bone ,medicine ,Humans ,SPHENOID SINUSES ,Child ,Ecology, Evolution, Behavior and Systematics ,Sinus (anatomy) ,business.industry ,Significant difference ,Endoscopy ,Retrospective cohort study ,Surgical procedures ,Endoscopic sinus surgery ,030104 developmental biology ,medicine.anatomical_structure ,Female ,Radiology ,Anatomy ,Internal carotid artery ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery ,Biotechnology ,Pediatric population - Abstract
Sphenoid sinus accessory septations and their possible insertion on internal carotid artery (ICA) may represent a risk for endoscopic sinus surgical procedures. However, scarce data on this variant for children are available so far. This retrospective study included 220 maxillofacial CT-scans equally divided among males (13.4 ± 2.1 years) and females (13.9 ± 2.2 years). On each CT-scan, prevalence of accessory septations, number of septations in sphenoid sinuses, and their possible insertion onto ICA bone walls were recorded. Significant differences in protrusion and insertion of septations onto the ICA bone walls according to sex were assessed through Chi-square test (p .05). Possible correlations between the prevalence of accessory septations, ICA insertion, and number of accessory septations and age were assessed by means of Pearson's regression (p .05). On average, 66% of males and 71% of females had at least one accessory septation, without significant differences according to sex or age (p .05): septal insertion on ICA was found in 13% of subjects, without any significant difference for sex or age (p .05). The number of septations was significantly increased with age (p .05). The present study showed that the prevalence of accessory septations and insertion onto the ICA are independent of age and these results are similar to those reported in adults. Results will be useful for the management of endoscopic sinus surgery.
- Published
- 2020
- Full Text
- View/download PDF
42. Sphenoid sinus development in patients with acquired middle ear cholesteatoma
- Author
-
Daisuke Sano, Goshi Nishimura, Nobuhiko Oridate, Naoko Sakuma, Yasuhiro Arai, Masahiro Takahashi, Masanori Komatsu, and Kentaro Sakamaki
- Subjects
Adult ,Male ,medicine.medical_specialty ,Sphenoid Sinus ,Chronic rhinosinusitis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Ethmoid Sinus ,otorhinolaryngologic diseases ,medicine ,Humans ,Middle Ear Cholesteatoma ,In patient ,Sinusitis ,030223 otorhinolaryngology ,Sinus (anatomy) ,Aged ,Rhinitis ,Aged, 80 and over ,Cholesteatoma, Middle Ear ,business.industry ,Nasal septal deviation ,Cholesteatoma ,General Medicine ,Middle Aged ,medicine.disease ,Pathophysiology ,Otitis Media ,medicine.anatomical_structure ,Paranasal sinuses ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Chronic Disease ,Female ,Surgery ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
In this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC.A total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund-Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control.The AMEC group showed a significantly shorter sphenoid length (P 0.01) and lower Vidic classification score (P 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group.Our results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.
- Published
- 2020
- Full Text
- View/download PDF
43. Capillary hemangioma of the sphenoid sinus excision through the endonasal endoscopic approach
- Author
-
H. Younes, F. Senghor, A. Tall, and M.S. Diouf
- Subjects
medicine.medical_specialty ,business.industry ,Capillary hemangioma ,sphenoid sinus ,General Medicine ,medicine.disease ,lcsh:Otorhinolaryngology ,lcsh:RF1-547 ,eye diseases ,Surgery ,medicine.anatomical_structure ,hemangioma ,medicine ,sense organs ,business ,endoscopic endonasal surgery ,Sinus (anatomy) - Abstract
Background: Sinonasal hemangiomas are rare, especially hemangiomas of the sphenoid sinus, for which very few cases have been reported. Observation: We report the case of a 20-year-old patient who had consulted for epistaxis associated with headache. A CT scan of the nose and sinuses revealed a heterogeneous tumor process filling the sphenoid sinus. A minimally invasive endonasal surgery under endoscopic guidance allowed complete removal of the tumor. The histological study of the surgical specimen had revealed capillary hemangioma. After 27 months of decline, no recurrence was noted. Conclusion: Capillary hemangioma is very rare in its sphenoidal location. Endonasal endoscopic excision allows optimal control, after a good pre-operative evaluation.
- Published
- 2020
- Full Text
- View/download PDF
44. The Whole Lateral Type of the Sphenoethmoidal Cell and Its Relevance to Endoscopic Sinus Surgery
- Author
-
Jinfeng Liu, Jingjing Yuan, Jinsheng Dai, and Ningyu Wang
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Sphenoid Sinus ,Computed tomography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Ethmoid Sinus ,Ethmoid sinus ,Paranasal Sinuses ,medicine ,Humans ,030223 otorhinolaryngology ,Sinus (anatomy) ,Aged ,Retrospective Studies ,0303 health sciences ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Middle Aged ,Endoscopic sinus surgery ,medicine.anatomical_structure ,030301 anatomy & morphology ,Otorhinolaryngology ,Onodi cell ,Optic Nerve Injuries ,Optic nerve ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Background: The sphenoethmoidal cell and the sphenoid sinus (SS) show great similarity in endoscopy and imaging. Hence, it is important to accurately identify the sphenoethmoidal cell preoperatively to prevent injury of the nerve and artery during endoscopic surgery. The aim of the present study was to investigate a special type of sphenoethmoidal cell. Methods: A total of 365 inpatients whose paranasal sinus computed tomography (CT) was collected and reviewed from May 2018 to September 2019 were included. The anatomical imaging characteristics of the sphenoethmoidal cell were observed. Results: A special type of the sphenoethmoidal cell was found on 9 sides in 730 sides (1.3%), according to its extension to the SS. Unlike Onodi cell (49.6%) and Jinfeng cell (1.3%), this cell simultaneously extends toward the superolateral, lateral, and inferolateral regions of the SS and is simultaneously closely attached to the optic canal and the maxillary nerve. Presently, this cell is named as the whole lateral type of the sphenoethmoidal cell, and the SS is located at the medial or inferomedial of it. Conclusions: When evaluating the paranasal sinus CT preoperatively, attention must be paid to the possibility of the whole lateral type of sphenoethmoidal cell appearing, not just Onodi cell, extending into the SS.
- Published
- 2020
- Full Text
- View/download PDF
45. Sphenoid sinuses: pneumatisation and anatomical variants—what the radiologist needs to know and report to avoid intraoperative complications
- Author
-
Carlo Martinenghi, Chiara Floridi, Michaela Cellina, Tahereh Toluian, Daniele Gibelli, Giancarlo Oliva, and Carlo Valenti Pittino
- Subjects
medicine.medical_specialty ,Sphenoid Sinus ,Sphenoid bone ,Surgical planning ,Pathology and Forensic Medicine ,03 medical and health sciences ,otorhinolaryngologic diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Sinusitis ,Intraoperative Complications ,Rhinitis ,0303 health sciences ,medicine.diagnostic_test ,business.industry ,Anatomic Variation ,Endoscopy ,Neurovascular bundle ,Paranasal sinuses ,medicine.anatomical_structure ,030301 anatomy & morphology ,Otorhinolaryngology ,Chronic Disease ,Surgery ,Radiology ,Neurosurgery ,Anatomy ,Tomography, X-Ray Computed ,business - Abstract
Sphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications. Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures.A literature search of PubMed and Embase (Elsevier) databases was performed using the keywords "sphenoid sinus" and "anatomy, "sphenoid sinus" and "anatomic variants", "sphenoid sinus", and "anatomic variations".We described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septations CONCLUSION: The information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.
- Published
- 2020
- Full Text
- View/download PDF
46. Long-term olfactory function outcomes after pituitary surgery by endoscopic endonasal transsphenoidal approach
- Author
-
Masahiro Tanji, Tatsunori Sakamoto, Fumihiko Kuwata, Mami Matsunaga, Masaru Yamashita, Masahiro Kikuchi, Masaaki Ishikawa, Takayuki Nakagawa, and Koichi Omori
- Subjects
Adenoma ,Adult ,Male ,Reoperation ,Olfactory system ,Pituitary gland ,medicine.medical_specialty ,Sphenoid Sinus ,Subgroup analysis ,Turbinates ,Surgical Flaps ,Transsphenoidal approach ,Olfaction Disorders ,03 medical and health sciences ,0302 clinical medicine ,Pituitary adenoma ,medicine ,Humans ,Pituitary Neoplasms ,Intraoperative Complications ,030223 otorhinolaryngology ,Aged ,Nasal Septum ,Cerebrospinal Fluid Leak ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Smell ,ACTH-Secreting Pituitary Adenoma ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Sensory Thresholds ,030220 oncology & carcinogenesis ,Neuroendoscopy ,Cohort ,Female ,Histopathology ,Growth Hormone-Secreting Pituitary Adenoma ,Nasal Cavity ,Neoplasm Recurrence, Local ,business - Abstract
Objectives To evaluate long-term olfactory outcomes in patients who underwent pituitary surgery through the endoscopic endonasal transsphenoidal approach (EETSA) by T&T olfactometer. Methods We retrospectively reviewed 26 patients who underwent pituitary surgery via EETSA. Olfactory function was assessed by T&T olfactometer before and 6 months after surgery. The mean of recognition thresholds for five different odorants was used. The change in the mean recognition threshold values was evaluated in the entire cohort and the subgroup analysis was performed according to the age, sex, past history of pituitary surgery (primary surgery or revision surgery), histopathology (non-functioning adenoma (NFA) or functioning adenoma (FA)), reconstruction procedure (rescue flap or nasoseptal flap), and superior turbinate management (preserved or resected). Results Of the 26 patients (12 men and 14 women, median age 53 years), 21 patients were newly diagnosed with pituitary gland tumor (16 NFAs, 5 FAs) and the remaining 5 were diagnosed with recurrent pituitary gland tumor (4 NFAs and 1 FA). In the whole cohort, the mean recognition threshold values of T&T olfactometer significantly improved after surgery (P = 0.01). Thirteen out of 26 patients (50%) showed olfactory improvement, whereas only 3 (12%) showed deterioration. In the subgroup analysis, olfactory function outcomes were not significantly different between the subgroups with respect to the age, sex, past history of pituitary surgery, histopathology, reconstruction procedure, or superior turbinate management. The olfactory function tended to worsen in the revision surgery group compared to that in the primary surgery group, but not significantly (P = 0.06). Conclusions The olfactory function was improved or maintained after pituitary surgery via EETSA in 88% of patients, indicating the benefits of low invasiveness of our surgical treatment. On the other hand, three patients (12%) demonstrated deterioration of olfactory function, suggesting that the risk of postoperative olfactory dysfunction should be informed to patients.
- Published
- 2020
- Full Text
- View/download PDF
47. The sphenoethmoidal sinus and the modified anatomy of the related structures
- Author
-
Mihai Săndulescu, Sorin Hostiuc, Julietta Cristina Sava, Mugurel Constantin Rusu, Carmen Aurelia Mogoantă, and Andrei Gheorghe Marius Motoc
- Subjects
nasal turbinate ,Male ,Embryology ,Fossa ,Maxillary sinus ,Sphenoid Sinus ,Perforation (oil well) ,Pathology and Forensic Medicine ,ethmoid cells ,Ethmoid Sinus ,sphenoidal sinus ,medicine ,otorhinolaryngologic diseases ,Humans ,Lateral nasal wall ,Sinus (anatomy) ,Retrospective Studies ,Original Paper ,Sphenoidal sinus ,biology ,business.industry ,Turbinates ,Cell Biology ,General Medicine ,Anatomy ,anatomic variation ,biology.organism_classification ,eye diseases ,medicine.anatomical_structure ,Pterygopalatine ganglion ,Female ,maxillary sinus ,business ,Developmental Biology - Abstract
The anterior extent of the sphenoidal sinus in the posterior ethmoid was less investigated. Our purpose was to study whether, or not, the occurrence of a sphenoethmoidal sinus (SES) relates to a sagitally-shortened ethmoid. A retrospective cone-beam computed tomography (CBCT) was performed on 36 patient files. In six patients were found SES extended anteriorly above the posterior third of the middle turbinate (MT). Two of these patients had bilateral SES with ethmoidal chambers included in the lateral and superior nasal walls and draining in the sphenoethmoidal recesses. The correlation between the nasion-to-concha sphenoidalis distance and the presence of SES was statistically significant (less than 40 mm in SES cases and more than 40 mm in non-SES cases). We also found: (i) superior turbinates (STs) with ethmoidal and sphenoidal insertions on one side and ethmoidal and maxillary insertions on the opposite side (the maxillary insertion of ST modifies surgical landmarks and was not previously reported), (ii) MT perforation and (iii) pterygoid recess of the maxillary sinus located beneath the pterygopalatine ganglion fossa. The SES thus shortens sagitally the lateral nasal wall but does not modify its morphology. The MT perforation, ST maxillary insertion and the pterygoid recess are rare anatomic variants not reported previously in our knowledge.
- Published
- 2020
48. Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis
- Author
-
Sang-Wook Kim, Young-Chul Kim, Dae Hwan Kim, Byeong Min Lee, Yeon-Hee Joo, Yung Jin Jeon, and Hyun-Jin Cho
- Subjects
medicine.medical_specialty ,Sphenoid Sinus ,03 medical and health sciences ,0302 clinical medicine ,Anterior ethmoidal artery ,Refractory ,medicine.artery ,Posterior ethmoidal artery ,Humans ,Medicine ,030223 otorhinolaryngology ,Ligation ,Sinus (anatomy) ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Soft tissue ,Arteries ,General Medicine ,Surgery ,Epistaxis ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Angiography ,Tomography, X-Ray Computed ,business ,Ethmoidal Artery ,Sphenopalatine artery - Abstract
Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL. Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups. All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P
- Published
- 2020
- Full Text
- View/download PDF
49. From the Occipital Condyle to the Sphenoid Sinus: Extradural Extension of the Far Lateral Transcondylar Approach with Endoscopic Assistance
- Author
-
Anne Laure Bernat, Valentina Tardivo, Eduard H.J. Voormolen, Nicolas Penet, Thibault Passeri, Moujahed Labidi, Francesco Zenga, and Sébastien Froelich
- Subjects
Adult ,Male ,Hypoglossal Nerve ,Sphenoid Sinus ,Hypoglossal canal ,Skull Base Neoplasms ,Neurosurgical Procedures ,Condyle ,03 medical and health sciences ,0302 clinical medicine ,Clivus ,Cadaver ,Chordoma ,medicine ,Humans ,Sinus (anatomy) ,Skull Base ,Petrous Apex ,business.industry ,Inferior petrosal sinus ,Organ Size ,Anatomy ,Occipital condyle ,Skull ,medicine.anatomical_structure ,Cranial Fossa, Posterior ,Occipital Bone ,030220 oncology & carcinogenesis ,Neuroendoscopy ,Surgery ,Neurology (clinical) ,Anatomic Landmarks ,Jugular Veins ,business ,Carotid Artery, Internal ,030217 neurology & neurosurgery ,Petrous Bone - Abstract
Background Surgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus. Methods We performed an anatomic study on 7 cadaveric specimens to describe the main landmarks and boundaries of the corridor. We also provide a clinical case to demonstrate the feasibility of the approach. Results In all specimens, using the space provided by the condyle, it was possible to drill the petrous bone up to the posterior wall of the sphenoid sinus following the direction of the inferior petrosal sinus. To successfully complete the approach, after the hypoglossal canal was exposed, endoscopic assistance was needed to overcome the narrowing of the visual field provided by the microscope. Conclusions In cases of invasive skull base tumor involving the craniovertebral junction and affecting its stability, the occipital condyle can be exploited as a deep keyhole to the homolateral and contralateral petrous apex, clivus, and sphenoid sinus.
- Published
- 2020
- Full Text
- View/download PDF
50. A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance
- Author
-
Anna Curlej-Wądrzyk, Janusz Skrzat, Robert Chrzan, Tomasz Gładysz, Michał P. Zarzecki, Małgorzata Mazur, Joe Iwanaga, Andrzej Urbanik, Marcin Lipski, Jerzy A. Walocha, Joanna Jaworek-Troć, and R. S. Tubbs
- Subjects
Adult ,Male ,Histology ,anatomy ,Sphenoid Sinus ,sphenoid sinus ,Computed tomography ,Paranasal Sinuses ,medicine ,SPHENOID SINUSES ,Humans ,Clinical significance ,sphenoid sinus ostium ,Sinus (anatomy) ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Sagittal plane ,Ostium ,Contrast medium ,medicine.anatomical_structure ,Paranasal sinuses ,Female ,Poland ,Anatomy ,business ,Nuclear medicine ,Tomography, X-Ray Computed - Abstract
Background: The purpose of this research was to evaluate the size of the sphenoid sinuses’ ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population. Materials and methods: The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes. Results: The average size of both sphenoid sinuses ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinuses ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm). Conclusions: Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.
- Published
- 2022
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.