Endoscopic surgical management of sphenoid sinus disease

Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature

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Isolated sphenoid opacification is a rare pathology that is increasingly being described and it represents 1–2% of sinus infections.

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The most frequent symptom associated with isolated sphenoid sinusitis is intractable headache.

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Isolated sphenoid sinusitis is usually treated surgically and endoscopic transnasal sphenoidectomy is the preferred surgical technique.

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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.

[Bilateral sphenoid sinus mucocele presenting as abducens nerve palsy: case report]

Mucocele is a rare, benign, cystic tumor affecting primarily adults. It arises within the sphenoid sinus and invades the orbit through bony destruction. The most frequent locations are frontal and fronto-ethmoidal; sphenoidal forms are rarer, and bilaterality is exceptionally rare. Ophthalmological signs with the risk of blindness required emergency treatment. The authors report a case of bilateral sphenoid mucocele presenting as an isolated abducens nerve palsy, the etiological investigation confirmed the diagnosis of sphenoid mucocele, and the treatment consisted of a surgical marsupialization through an endonasal endoscopic approach.

Isolated sphenoid sinus diseases: report of 76 cases

CONCLUSION

Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications.

OBJECTIVES

The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years' experience.

PATIENTS AND METHODS

Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes.

RESULTS

Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.

[Endoscopic surgical treatment of patients with isolated sphenoid sinus disease]

INTRODUCTION

Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential - nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease.

MATERIAL AND METHODS

Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall.

RESULTS

The patients' postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination.

CONCLUSIONS

Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

Isolated sphenoid sinus disease

Disease of the sphenoid sinus is often vague and nonspecific in its clinical presentation. Therefore, the otolaryngologist must maintain a high index of suspicion when evaluating patients who present with such nonspecific symptoms. A thorough understanding of the radiologic characteristics of sphenoid sinus disease is essential in the proper evaluation and management of these patients.

Measures of health-related quality of life for adults with acute sinusitis. A systematic review

CONTEXT

Symptoms suggestive of acute sinusitis are a common reason for patients to visit primary care providers. Since objective measures of outcome have not been shown to be related to patient reported outcomes, measures of treatment success have focused on symptom relief and improved health-related quality of life (HRQL). Assessing the appropriate role of treatment - for example, antibiotics for patients with acute sinusitis - requires valid, reliable, and responsive measures of outcome. We identified symptom scores and HRQL instruments for adults with sinusitis and assessed their performance characteristics.

DATA SOURCES

Articles identified through computer searches of the medline, premedline, and embase databases, the Cochrane Library, and internet documents; inquiries to experts in sinusitis and outcomes assessment; and review of reference lists.

STUDY SELECTION

Studies that used HRQL instruments or evaluated the performance characteristics of symptom scores in adults with sinusitis, published in English after 1966.

DATA EXTRACTION

Two reviewers independently extracted data on study design, setting, and patient characteristics; instrument length and format; and instrument validity, reliability, responsiveness to change, and interpretability. Study quality was assessed using a 10-point score.

DATA SYNTHESIS

Of 1,340 articles in the original search, 29 articles using 16 HRQL instruments and 5 symptoms scores met inclusion and exclusion criteria. The overall quality of these studies was low; only 4 studies scored higher than 4 of 10 points. Four studies included patients with acute sinusitis, but only 2 included exclusively acute sinusitis patients. Three instruments have been shown to meet basic requirements for validity, reliability, and responsiveness: the Chronic Sinusitis Survey, the Rhinosinusitis Outcome Measure-31, and the Sinonasal Outcome Test-16. No instrument has been validated in a primary care setting or for patients with acute sinusitis.

CONCLUSIONS

Few validated measures of sinusitis-specific HRQL are available. The 3 instruments shown to be valid, reliable, and responsive have been assessed in patients with chronic sinusitis. No measure has been validated in primary care settings or for patients with acute sinusitis. A lack of valid, responsive outcome measures may limit current treatment recommendations for patients with acute sinusitis.

The intracranial complication of acute isolated sphenoid sinusitis

Acute isolated sphenoid sinusitis is a rare, potentially destructive entity, which has indistinct clinical findings and non-specific symptoms. Hence, it can be easily be misdiagnosed. We present and discuss a case of an isolated sphenoiditis with intracranial complication.