Hu Peng, Zhu Ganghua, Lai Ruosha, Zhu Famei, Xiao Zi'an, Yang Xinming, Li Youzhong
Department of Otorhinolaryngology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Mar;25(5):217-9.
To review the clinical manifestations and management of nasal sinus mucoceles with visual loss.
Medical records for 23 patients of paranasal sinus mucoceles with visual impairment were re viewed retrospectively during 8-year period (from 2002 to 2010). Ten mucoceles were found in the frontal or fronto-ethmoidal sinuses, 6 in the ethmoidal sinuses, 7 in the sphenoidal or spheno-ethmoidal sinuses. Because the majority of early chief complaints were problems related to vision, patients were often seen by ophthalmologists first. Poor vision was more common in patients with sphenoid or spheno-ethmoidal sinus mucoceles because of their proximity to the optic nerve. CT and MRI were important tools for diagnosing nasal sinus mucocele. The patients received endoscopic surgery to remove mucocele and to decompress the optic nerve. Steroid therapy was given postoperatively and routine examination with endoscopy were carried out during follow-up.
Postoperatively, the majority of symptoms, such as exophthalmos, epiphora, diplopia and headache, disappeared in all patients. However, vision recovery was observed only in some patients. Recovery of vision depended on the timing of surgery and severity of initial visual loss. Delay in treatment can seriously compromise recovery of vision impairment. Moreover, patients without light perception before surgery had poor visual recovery even if optic nerve decompressions were performed.
Endoscopic surgery is effective to nasal sinus mucocele with visual loss. Because visual recovery depends on prompt diagnosis and surgical intervention, a good understanding of the disease and prompt imaging studies are important.
回顾性分析伴有视力丧失的鼻窦黏液囊肿的临床表现及治疗方法。
回顾性分析2002年至2010年8年间23例患有视力损害的鼻窦黏液囊肿患者的病历。10例黏液囊肿位于额窦或额筛窦，6例位于筛窦，7例位于蝶窦或蝶筛窦。由于早期的主要症状大多与视力问题有关，患者通常首先由眼科医生诊治。蝶窦或蝶筛窦黏液囊肿患者视力下降更为常见，因为其靠近视神经。CT和MRI是诊断鼻窦黏液囊肿的重要工具。患者接受了内镜手术以切除黏液囊肿并对视神经进行减压。术后给予类固醇治疗，并在随访期间进行常规内镜检查。
术后，所有患者的大多数症状，如眼球突出、流泪、复视和头痛等均消失。然而，仅部分患者视力得到恢复。视力恢复取决于手术时机和初始视力丧失的严重程度。治疗延迟会严重影响视力损害的恢复。此外，术前无光感的患者即使进行了视神经减压，视力恢复也较差。
内镜手术对伴有视力丧失的鼻窦黏液囊肿有效。由于视力恢复取决于及时诊断和手术干预，因此对该疾病的充分了解以及及时的影像学检查很重要。
