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The abducens nerve, which is vulnerable because of its complex anatomy at the skull base, is seldom affected by acute or severe sphenoid sinusitis. Notably, abducens nerve palsy following asymptomatic chronic rhinosinusitis (CRS) in a healthy young individual after a mild upper respiratory infection (URI) remains undocumented in the literature. Herein, we report a case of acute unilateral abducens neuropathy in a healthy 35-year-old woman with CRS in the ipsilateral sphenoid sinus, following a mild URI 2 weeks earlier. She presented with sudden-onset diplopia, was afebrile, and had normal serum inflammatory biomarkers. Comprehensive ophthalmological and neurological exams revealed no abnormalities except limited lateral gaze in the left eye. Imaging revealed mucosal swelling on the hyperpneumatized left sphenoid sinus, which thinned the clivus and positioned the inflamed mucosa close to the Dorello's canal, likely facilitating the spread of inflammation to the ipsilateral abducens nerve. Urgent endoscopic sinus surgery combined with systemic corticosteroids and antibiotics led to complete resolution by postoperative day 10. The present case demonstrates acute abducens nerve neuropathy from URI-induced exacerbation of sphenoid sinus CRS with specific anatomical predispositions., Competing Interests: Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

Objective: Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity., Methods: A chart review and review of the literature., Results: We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole., Conclusions: GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A diabetic woman in her fifties presented with a sudden onset of failing vision and diplopia involving the right eye for two days, along with fever and headache. Radiological investigations revealed right sphenoid sinusitis along with inflammation around the right orbital apex and optic nerve. Functional endoscopic sinus surgery, with orbital and optic nerve decompression improved the ocular movements, but not the visual acuity. Histopathology was suggestive of a granulomatous inflammatory lesion, and high-resolution computed tommography (HRCT) of the thorax revealed lung lesions suggestive of an old tubercular infection, and antitubercular treatment (ATT) was then initiated.At the end of two months of ATT, there was complete resolution of ophthalmoplegia, relative afferent pupillary defect, direct and consensual light reflex however, failure of improvement in her visual acuity, indicated damage to the optic nerve.Extrapulmonary tuberculosis involving an isolated sphenoid sinus is rare and elusive. Prompt radiological investigations, followed by orbital decompression and ATT, provide the best possible outcomes., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: The authors report no conflicts of interest.

The article presents a case of a 54-year-old female patient who, over the course of 2 years, suffered 5 cerebrovascular accidents (CVA) due to infectious arteritis of both internal carotid arteries (ICA) and basilar artery as a complication of sphenoiditis and otitis. According to neuroimaging data, the steno-occlusive process in the ICA developed gradually, starting with the intracranial ICA narrowing with the contrast enhancement by vessel wall, the development of its occlusion six months later, and the detection of the extracranial ICA occlusion with the formation of «flame sign» at its mouth a year later. Repeated examination of the cerebrospinal liquid at an early stage of the disease revealed cytosis up to 367/3 and protein 0.66 g/l. The correct diagnosis was established only after 3 years with a retrospective analysis of clinical, neuroimaging, and laboratory data. Therefore, targeted antibiotic therapy was not carried out, which led to the progression of ICA occlusion and repeated strokes. Infectious arteritis should be taken into account in the differential diagnosis of the causes of the ICA occlusive process.

Competing Interests: The authors report no conflicts of interest.

Sphenoid sinusitis is a rare disease associated with life-threatening complications that can be avoided with early recognition and timely treatment. Here, we present a case of a woman in her 80s admitted for symptomatic anaemia likely secondary to a gastrointestinal bleed with left cranial nerve (CN) VI palsy incidentally discovered on physical examination. CT and MRI were suggestive of chronic left sphenoid sinusitis with possible involvement of the left cavernous sinus. Surgical treatment was deferred due to high cardiac risk for perioperative mortality and recent ischaemic stroke. Despite antibiotic treatment, the patient's CN VI palsy remained unchanged. This report contributes to the current understanding of sphenoid sinusitis by presenting a complex case of chronic sphenoid sinusitis in which urgent surgical intervention was deferred due to the patient's multiple comorbidities. Furthermore, it highlighted the importance of the CN examination and imaging modalities in diagnosing sphenoid sinusitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis has usually a good prognosis, IFS is a potentially lethal condition.We report the case of a woman in her 60s presenting an isolated fungal infection by Aspergillus fumigatus of the right sphenoid sinus, causing extensive bone erosion of its walls and complicated by severe meningoencephalitis. She was healthy without any immunosuppressive conditions. Methods of diagnosis, multidisciplinary management, follow-up and outcomes are documented.Early-stage diagnosis of sphenoid sinus pathologies is often delayed because patients are usually asymptomatic. IFS of the sphenoid is more aggressive than other paranasal sinus and carries significant mortality. Early diagnosis and aggressive and multidisciplinary treatment are crucial to reduce sequels and improve patient's survival., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia caused by idiopathic granulomatous inflammation involving the cavernous sinus region. Patients respond well to steroid therapy. THS is included in the differential diagnosis of cavernous sinus syndrome, so it is important to fully exclude other lesions in this area before treatment, otherwise steroid treatment may lead to fatal outcomes. Here we describe a patient who initially presented with symptoms that simulated THS symptoms and developed recurrent alternating painful ophthalmoplegia during follow-up, and the patient was finally diagnosed with cavernous sinusitis caused by bacterial sphenoid sinusitis., Case Presentation: A 34-year-old woman presented with left painful ophthalmoplegia. Magnetic resonance imaging (MRI) revealed abnormal signals in the left cavernous sinus area, and these abnormal signals were suspected to be THS. After steroid treatment, the patient obtained pain relief and had complete recovery of her ophthalmoplegia. However, right painful ophthalmoplegia appeared during the follow-up period. MRI showed obvious inflammatory signals in the right cavernous sinus and right sphenoid sinus. Then nasal sinus puncture and aspiration culture were performed, and the results showed a coagulase-negative staphylococcus infection. After antibiotic treatment with vancomycin, the painful ophthalmoplegia completely resolved, and the neurological examination and MRI returned to normal., Conclusion: Some other causes of painful ophthalmoplegia also fulfill the diagnostic criteria for THS in the International Classification of Headache Disorders third edition (ICHD-3) and respond well to steroid therapy. Early diagnosis of THS may be harmful to patients, and clinicians should exercise great caution when dealing with similar cases without a biopsy. Using "cavernous sinus syndrome" instead of "Tolosa-Hunt syndrome" as a diagnostic category may provide a better clinical thinking for etiological diagnosis., (© 2023. The Author(s).)

This article presents an analytical review of scientific publications on the topic of surgical treatment of isolated lesions of the sphenoid sinus. The publications, research data presented in the RSCI database, PubMed in the period 1985-2021 are analyzed. The selection of the material was carried out according to the keywords: sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis, endoscopic sphenotomy, relapses of sphenoiditis, sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis.

Isolated sphenoid sinus disease is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurological and vascular structures nearby. Early recognition and treatment are critical to prevent the progression of the disease. We present a case of a 60-year-old woman with a history of severe left-sided headache, facial pain, diplopia and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. Magnetic resonance imaging revealed opacification in left sphenoid sinus with cavernous sinus/superior orbital fissure involvement consistent with left sphenoid sinusitis. She was then referred to the ear, nose and throat department and had endoscopic transnasal sphenoidotomy in theatre. Culture results showed Haemophilus influenza and fungal pseudohyphae. She recovered three months later after a course of antibiotics and antifungals. The onset of isolated sphenoid sinus disease is often insidious and the diagnosis of this condition remains a challenge. Magnetic resonance imaging and computed tomography remain the best diagnostic tools to recognise and manage this condition.

We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus , a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

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Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition., Data Sources: Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar., Study Selection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications., Results: Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported., Limitations: All studies were retrospective case note reviews., Conclusions: Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT)., Methods: In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated., Results: The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells., Conclusion: Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.

Fungus ball (FB) is the most common form of extramucosal fungal rhinosinusitis involving one or more paranasal sinuses. The sphenoid sinus is an uncommon site of this disease. Here, we present our 20-year experience of managing isolated sphenoid sinus FB (SSFB). We retrospectively reviewed a series of 47 cases of isolated SSFB encountered between 1996 and 2015 with reference to the chronological incidence, demographics, clinical features, radiological findings, treatment modalities, and outcome. Recently, the number of patients with isolated SSFB has increased markedly. The mean age of the patients in this study was 63.1 years (range 26-84 years), and there was significant female predominance. The most common symptom was headache (72.3%), which was localised in various regions. On the other hand, nasal symptoms presented at a relatively low rate. On computed tomography, the most common findings were total opacification, calcification, and sclerosis of the bony walls. There was no significant difference in the presence of SSFB between the ipsilateral and contralateral sides of the nasal septal deviation and concha bullosa. Magnetic resonance imaging demonstrated an isointensity on T1-weighted images and marked hypointensity on T2-weighted images. Treatment consisted of endonasal endoscopic sphenoidotomy with complete removal of the FB. The prognosis was good, with no recurrence after a mean follow-up of 13.2 months. Isolated SSFB is a rare disease, but its prevalence is increasing. Although the clinical presentation is usually vague and nonspecific, SSFB should be considered in patients with unexplained headache, especially in elderly women. Endoscopic sphenoidotomy is a reliable treatment with low morbidity and recurrence rates.

Objective: To analyze the clinical characteristics of fungus ball sphenoid sinusitis(FBSS) and its differences from fungus ball maxillary sinusitis(FBMS). Method: A retrospective analysis was made for 50 patients with FBSS and 273 patients with FBMS in the corresponding period, which were confirmed by postoperative pathological diagnosis. And the related factors and clinical characteristics of them were analyzed. Result: FBSS were common disease in women around 50 years old. The left side FBSS was more common than the right side. About 40 percent of patients' disease course was less than half a year.FBSS had many presenting symptoms such as headache, nasal obstruction, nasal mucus with blood, smelly nasal secretions, eye ache bilges or nasion acheand tears spill. However, headache, eye ache bilges and tears spill were more common in FBSS compared with FBMS( P <0.05). The CT scan showed that there were calcification shadows in the diseased softtissue of sinus cavity.It could be accompanied by local bone thickening, sclerosis and coloboma. Only one case had a secondary surgery in 50 cases of FBSS. The surgery cure rate was as high as 98 percent. Conclusion: FBSS had various of clinical symptoms.Some presenting symptoms such as headache, eye ache bilges, and tears spill had relative specificity. CT diagnosis was more specific, and the endoscopic sphenoidotomy was the most effective treatment., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

A 33-year-old immunocompetent man developed rapid visual loss and a third nerve palsy secondary to acute rhinosinusitis and intracranial abscess formation. Despite endoscopic drainage of the ethmoid and sphenoid sinuses and empiric broad-spectrum antibiotics, the patient experienced progressive visual and neurological decline and ultimately required craniotomy for drainage of an optic apparatus abscess. Although odontogenic sinusitis rarely results in abscess formation of the visual pathways, early recognition and immediate treatment is imperative to decrease the risk of profound and permanent visual impairment.

Objective: This study was designed to retrospectively review the postoperative results of transnasal transostial sphenoidotomy in 79 patients with isolated chronic sphenoid sinusitis operated between 1995 and 2013 and evaluate the recurrence rate due to postoperative closure of the sphenoidotomy., Patients and Methods: Seventy-nine patients, 44 women and 35 men (M:F sex ratio: 0.79) aged 10 to 84 years (mean age: 48), were included. The most common presenting symptom was headache in 61% of cases. Visual disturbances were present in three cases. The diagnostic work-up comprised nasal endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) of the sinuses. The surgical indication was based on failure of antibiotic therapy and/or the nature and severity of sphenoid sinusitis. All patients were operated by endoscopic transnasal transostial sphenoidotomy. Samples were taken for histological, bacteriological and mycological examination., Results: No intraoperative or immediate postoperative complications were observed. Nature of the lesion: forty-seven patients (59.5%) presented nonspecific inflammatory lesions with negative bacterial or fungal culture and inflammatory mucosal changes, 19 patients (24%) had fungal sinusitis presenting as a fungus ball and 13 patients (16.4%) had documented bacterial sinusitis. Mean postoperative follow-up was 7.4 months (range: 6-48). No recurrence of the sinusitis or symptoms was observed in 71 cases (89.8%). Recurrence: eight cases (10.2%) of postoperative closure of the sphenoidotomy were observed, requiring one (6 cases) or several (2 cases) reoperations with a mean of 16.4 months after the initial procedure. Symptoms of recurrence consisted of varying degrees of headache, with similar symptoms to those of the first episode in 7 cases, and retro-orbital headache in 1 case. Reoperation was performed via a transnasal transostial approach in 6 cases and a transethmoidal approach in 2 cases., Conclusion: The transnasal transostial surgical approach is a safe and effective procedure for the treatment of isolated sphenoid sinusitis. However, the recurrence rate due to postoperative closure of the sphenoidotomy observed in our series raises the question of postoperative maintenance of a patent and functional sphenoidotomy., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

In immunocompromised patients, invasive molds such as Aspergillus and Mucor can lead to locally aggressive angioinvasive infections that are often life-threatening. A particularly devastating complication is the development of a fungal mycotic aneurysm resulting from invasion of the arterial wall. Due to anatomic contiguity, the sphenoid sinus provides potential access for these fungi, which often colonize the respiratory sinuses, into the cavernous sinus and internal carotid artery (ICA), thus leading to the formation of ICA aneurysms. The ideal treatment of fungal ICA aneurysms includes a combination of surgical debridement and long-term effective antifungal therapy, but the role of endoscopic resection and the duration of antimicrobials are poorly defined. Here, we present the case of a 71-year-old immunocompromised patient who developed an ICA mycotic aneurysm, associated with a proven invasive fungal infection (presumptively Mucorales) of the sphenoid sinuses, as defined by EORTC/MSG criteria, and who survived after undergoing coil embolization with parent vessel sacrifice of the aneurysm in combination with liposomal amphotericin B. We also review the literature for published cases of invasive fungal sphenoid sinusitis associated with mycotic aneurysms of the ICA and provide a comparative analysis .

Objective: To analyze the possible influence factors of sphenoid sinusitis after endoscopic transsphenoidal sellar surgery., Methods: A retrospective analysis of 177 patients who underwent transsphenoidal sellar surgery, from January 2009 to January 2014 in Tianjin Huanhu Hospital was performed. All patients were followed up with nasal endoscope. The risk factors of sphenoid sinusitis after surgery were analyzed statistically, such as sex, age, categories of disease, surgical produres, tumor size, using artificial or self material repair, with or without EC glue intraoperatively, etc. SPSS 17.0 software was used to analyze the data., Results: After surgery, there were 34 (19.2%) patients developed postoperative sinusitis. EC glue was the sole risk factor for postoperative sinusitis (34.57% vs 6.25%, χ(2)=22.701, P<0.01), but the sex, age, categories of disease, surgical produres, tumor size and patching material had no significant difference (all P>0.05)., Conclusions: In patients with endoscopic transsphenoidal sellar surgery, regular postoperative nasal endoscopic follow-up found that the use of EC glue was the risk factor for the development of postoperative sphenoid sinusitis.

Isolated sphenoid sinusitis is a rare disorder and may present with complications due to its anatomical location and proximity to the intracranial and orbital contents. It is frequently misdiagnosed, because the sphenoid sinus is not visualised adequately with routine sinus radiographs and is not accessible to direct clinical examination. We report a case who presented with hemicranial headache and ipsilateral abducens nerve palsy as the presenting feature of sphenoid sinusitis. The symptoms disappeared within a week of conservative treatment. Sphenoid sinusitis should be kept in the differential diagnosis of isolated sixth cranial nerve palsy, especially in the presence of headache, and all patients should be investigated with CT/MRI brain. Prompt diagnosis and management before intracranial extension can prevent devastating complications., (2015 BMJ Publishing Group Ltd.)

We present a case of sphenoid sinus fungus ball caused by Aspergillus fumigatus associated with actinomycosis. This case represents the first known reported infection caused by this rare association.

A 61-year-old Japanese woman presented with a headache and appetite loss lasting for nine days and was admitted to our hospital, where she was diagnosed with pneumococcal meningitis associated with acute sphenoid sinusitis. While the administration of meropenem and dexamethasone ameliorated the meningitis, right third and sixth nerve palsy suddenly developed 10 days after admission. CT angiography subsequently demonstrated an aneurysm in the cavernous portion of the right internal carotid artery. This is the first reported case of sphenoid sinusitis simultaneously complicated by both pneumococcal meningitis and an infectious aneurysm in the intracavernous carotid artery.

Non-traumatic intracranial acute epidural hematoma(EDH)is rare. It is mostly caused by coagulation disorders, dural metastasis, or vascular malformations of the dura. We report a case of non-traumatic acute EDH caused by chronic nasal sinusitis and review the literature comprising 10 cases of acute EDH caused by chronic nasal sinusitis. A 16-year-old boy visited our outpatient clinic with a 2-day history of severe headache. He did not have fever or neurological abnormalities and showed no evidence of head trauma. Cranial computed tomography(CT)revealed sphenoid sinusitis and a small amount of epidural air in the middle fossa, but no other intracranial abnormalities. After eight days with no subsequent history of trauma, radiological exams showed a massive acute epidural hematoma in the left middle fossa and temporal convexity without any vascular lesion or skull fracture. The patient underwent a hematoma evacuation that revealed neither a skull fracture nor a vascular abnormality. In this adolescent, chronic nasal sinusitis caused fragility of the meningeal artery wall, an air collection in the epidural space, and the detachment of the dura mater from the inner surface of the skull, thereby resulting in a non-traumatic acute EDH.

Background: Sphenoid sinus lesions are rare entities, occurring in 2 - 3% out of all paranasal sinus lesions. Isolated oculomotor nerve palsy due to acute sphenoid sinusitis is very rare, with only few cases reported in literature., Methods: Retrospective report about a case of isolated acute sphenoid sinusitis in a child with a left-sided third cranial nerve paralysis as the only sign at presentation., Results: Isolated oculomotor nerve palsy can be the initial sign of an isolated acute sphenoid sinusitis in children and it requires a high index of suspicion in order to avoid a delay in diagnosis., Conclusions: Magnetic resonance imaging should be promptly performed. Functional endoscopic sinus surgery represents the treatment of choice in order to restore sinus drainage and avoid further intracranial or ocular complications. The need of serial postoperative debridement under general anesthesia should be adequately scheduled and previously discussed with parents.

A fungus ball usually appears as a calcification within the sinus, suggesting the presence of a foreign body.

Isolated sphenoiditis is an uncommon disease, particularly in children. Immediate antibiotic therapy and/or endoscopic transnasal sphenoidotomy should be performed to avoid fatal complications. However, the commonly used transnasal route is not always available in children with a cleft lip and deviated nasal septum. We report a case of acute isolated sphenoid sinusitis in a 12-year-old boy with a cleft lip and deviated nasal septum. This patient underwent combined endoscopic transnasal and intrasphenoidal septal surgery and improved without septoplasty, which may affect the later growth of the nose., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications., Aim: Describe four patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of medical or surgical management. Two patients do not required surgical intervention and medical treatment was sufficient. One patient had sphenoidotomy due to meningitis. One patient was performed surgical intervention after fail of medical therapy. Acute isolated sphenoid sinusitis appears to be difficult to diagnose. It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Medical therapy focused on infection, inflammation, and obstruction may be adequate for resolution, but surgical intervention may be required in certain situations., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Background: Isolated sphenoid sinus disease (ISSD) is rare. Fungus ball (FB) is the third most common ISSD. We analysed the characteristics of isolated sphenoid FB based on demographic data, presenting symptoms, preoperative computed tomography (CT), magnetic resonance imaging (MRI), and treatment outcomes., Methodology: From 1999 to 2012, 29 patients were identified with isolated sphenoid FB. Demographic data; clinical characteristics; endoscopic, CT, and MRI findings and treatment outcomes were retrospectively analysed., Results: The most common symptom was headaches, which were localized in various regions of the brain. Other symptoms were uncommon. The most common CT findings were sclerosis, calcification, enlarged sinus and total opacification. On T2-weighted MRI images, we most commonly observed signal void. Endoscopic transnasal paraseptal sphenoidotomy was performed in all patients, and for most, this was performed under local anaesthesia. No recurrence was observed in any patient., Conclusion: Isolated sphenoid FB is predominantly observed in older women, and it is characterised by headaches and sclerosis of the sinus wall observed on CT scans. In cases of isolated sphenoid FB, endoscopic transnasal paraseptal sphenoidotomy can be successfully performed under local anaesthesia, which may facilitate rapid recovery and a low morbidity rate.

Introduction: The objective of this article was to report a case of isolated, acute, right-sided sphenoid sinusitis that progressed to contralateral cavernous sinus thrombosis in an 18-year-old male patient. We describe the atypical presentation of this case and discuss the relevant anatomy, pathogenesis, presentation, diagnostic evaluation and treatment., Case Report: A case report of sphenoid sinusitis leading to contralateral cavernous sinus thrombosis was reviewed and presented along with a comprehensive literature review of the relevant anatomy, pathophysiology, microbiology, diagnostic work-up and treatment options., Conclusion: Cavernous sinus thrombosis is a rare clinical entity in the antibiotic era. However, limited sphenoid sinusitis may progress to cavernous sinus thrombosis in spite of maximal medical treatment, as highlighted in this case report. The mainstay of treatment includes early diagnosis allowing aggressive intravenous antibiotics and appropriate surgical management.

A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.

Objective: Isolated sphenoid sinus aspergilloma (ISSA) is a rare disorder that is difficult to diagnose in a timely manner. These lesions can also extend to adjacent structures and thereby cause severe complications. ISSA patients with orbital complications typically have a poor prognosis even when surgical interventions have been successful. We here reviewed 30 ISSA cases with respect to clinical characteristics and treatment outcomes., Methods: A group of 30 patients diagnosed with ISSA between January 1990 and October 2010 were retrospectively reviewed in terms of clinical manifestations, endoscopic findings, radiologic imaging data, and treatment results. We also compared the clinical manifestations and treatment results between patients with and without orbital complications., Results: Old age (median, 55 years) and a female predominance (23 women in the study) were noted. The most commonly reported symptom was headache (80%) and the average duration of the symptoms before diagnosis was 8.1 months. On radiologic examination, including CT and MRI scans, 13 patients showed bony wall erosions and five patients demonstrated orbital complications including diplopia and visual loss. The appearance of a bony wall erosion on a CT scan and the acute onset of ISSA symptoms were found to be significant factors in the onset of orbital complications (P=0.003 in each case). Endoscopic sphenoidotomy was performed in all 30 cases. Most of the preoperative symptoms among the patients, including headache, facial pain, and postnasal drip, were improved after surgery. Among the five patients in the study group with orbital complications, diplopia was completely resolved after surgery in each case but there was no improvement in visual loss., Conclusions: An early diagnosis of ISSA, although not easy, is important to prevent complications arising from extensions of these lesions beyond the sphenoid sinus. Our present study demonstrates that ISSA could be effectively treated with an endoscopic sphenoidotomy, and that timely intervention is needed in patients with a sinus bony wall to prevent irreversible complications such as visual loss., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The objective of this retrospective study is to present a large series of patients with sphenoid sinus fungus ball (SSFB) and describe clinical manifestations, diagnostic workup, surgical treatment, and eventual complications of this disease. We included patients operated on for this disease over a 14-year period. All patients benefited from mid-to-long-term follow-up. There were 28 patients (18 females, 10 males, mean age 64 years). Main symptoms were posterior rhinorrhea and headache. Less common symptoms were alteration of vision or ocular mobility and cacosmia. Preoperative diagnosis was based on nasal endoscopy and CT scanning. MRI was performed in case of suspicion of a tumor, an intraorbital or intracranial invasion. Treatment consisted in endoscopic transnasal or transethmoidal sphenoidotomy with removal of the fungus ball. Specimens were sent to pathology and mycology to confirm diagnosis. Postoperative complications consisted of two cases of epistaxis and two other cases of bacterial superinfection of the operated sphenoid cavity. No recurrence of the fungus ball was seen after a mean follow-up of 13 months. To conclude, SSFB is a relatively uncommon entity, usually due to Aspergillus infection. Although not invasive, if left untreated, it can lead to long-term serious complications. Preoperative nasal endoscopic examination and CT scan are the standard tools for diagnosis. Endoscopic sphenoidotomy with removal of the fungus ball is the current treatment because it has proven effective and has a low morbidity and recurrence rate.

Headaches secondary to paranasal sinus disease are a common problem in otolaryngology practice. However, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs) are an extremely rare presentation of sinusitis. We report for the first time an unusual case of acute sinusitis presenting with SUNCTs-like symptoms with radiographically-proven isolated ipsilateral sphenoiditis, without any other intracranial pathologies. This case demonstrates an additional spectrum of acute sinusitis, which should be familiar to the otolaryngologist population., (Published by Elsevier Inc.)

Objective: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features., Method: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy., Result: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms., Conclusion: Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.

Background: Acute, isolated sphenoid sinusitis is a rare but potentially devastating clinical entity. Missing this diagnosis can lead to permanent vision loss due to injury of the optic nerve. Patients may present with preseptal inflammation, lid edema, chemosis, or ophthalmoplegia., Objective: We report a case of acute sphenoid sinusitis in a 10-year-old child who presented to the Emergency Department with essentially painless vision loss., Case Report: Previously healthy, the patient reported progressive decrease in vision in her right eye for the 5 days prior. Other than blurred vision in the right eye, she complained of a mild frontal headache and right eye irritation the past week, which had abated. On examination, she was reading a book with her head tilted to one side. She had no photophobia, or facial or eyelid swelling. Her pupils were 5 mm bilaterally, but the right was non-reactive to light. She was unable to see two fingers 6 inches in front of her face (right eye), whereas her visual acuity on the left was 20/25. She had bilateral elevated intraocular pressures and a Marcus Gunn pupil on the right. Ophthalmology was consulted and the diagnosis of acute sphenoid sinusitis causing compression and vascular compromise to the optic nerve was diagnosed ultimately by magnetic resonance imaging. The patient was transferred to the nearest pediatric specialty hospital, where an emergent endoscopic sphenoidotomy was performed. The patient's vision subsequently returned., Conclusion: Sphenoid sinusitis should be considered in patients presenting with acute vision loss. Awareness, early diagnosis, and intervention help prevent permanent complications., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: Sphenoid sinusitis is uncommon, and aspergillus infections represent a minority of these cases. This study was designed to describe the characteristics of this disease and present a review of the literature., Patients and Method: Retrospective study from 2004 to 2010 based on 15 patients managed at Nantes University Hospital. Risk factors and history, symptoms, intranasal examination, imaging, histological and mycological results as well as analysis of the response to treatment and outcome were analysed., Results and Discussions: Patients were aged between 14 to 78 years, almost 75% of patients were older than 50 and 73% of patients were women. The most common symptoms were headache [80%], nasal blockage or discharge [33%], and recurrent mild epistaxis [20%]. Predisposing factors were immunodepression in three patients, with no cases of diabetes. Two patients had a history of intranasal surgery and one had a history of facial trauma. Nasal endoscopy was normal in 40% of cases. CT was suggestive of sphenoid sinus aspergillosis in more than one half of cases [8/15] and demonstrated osteolysis in four patients. An incorrect preoperative diagnosis of mucocele was proposed in three patients. Histological examination demonstrated spore-forming structures in every case, but culture was positive in only four cases. Only two patients required antifungal therapy, including one patient with invasive aspergillosis., Conclusion: Chronic noninvasive sphenoid sinus aspergillosis appears to be a benign disease, essentially affecting women and patients over the age of 50 years. Symptoms are fairly non-specific. Imaging and histological examination are essential for management. The invasive form is a serious disease requiring rapid, multidisciplinary management., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Septic cavernous sinus thrombosis is a rare and potentially life-threatening complication of infections involving the paranasal sinuses or the middle one-third of the face. We report a challenging case of cavernous sinus thrombosis to familiarize otolaryngologists with its clinical features, diagnosis, and management. The patient was a 45-year-old diabetic woman whose signs and symptoms mimicked those of complicated fungal sinusitis. She presented with fever, nausea without vomiting, frontal headache, bilateral ptosis and swelling, double vision, a partial loss of visual acuity in the left eye, and restricted lateral ocular movements. Her Snellen visual acuity had been reduced to 8/10 on the right and 6/10 on the left. Radiologic investigation revealed cavernous sinus extension of sphenoid sinusitis and a fungus-ball appearance in the sphenoid sinus. On the second day of her admission, the patient's vision was further reduced to 6/10 on the right and 2/10 on the left. She then underwent urgent bilateral anterior and posterior ethmoidectomy and sphenoidectomy. At postoperative follow-up, her vision had stabilized at 10/10 bilaterally. At 2 months after discharge, she exhibited no evidence of abducens nerve palsy, and her ocular function had returned to normal. The diagnosis of cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging. The favorable outcome in our case was attributable to early diagnosis, prompt initiation of appropriate intravenous antibiotic therapy, and surgical drainage by the skillful surgical team.