Chao Chih-Chen, Lin Yi-Tsen, Lin Chih-Feng, Chiang Ching-Wen, Lin Hsuan-Chih, Yeh Te-Huei
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2021 Aug;120(8):1554-1562. doi: 10.1016/j.jfma.2020.11.005. Epub 2020 Nov 25.
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.
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.
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%.
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.
孤立性蝶窦疾病（ISSD）是一种罕见的临床病症，可能引发严重并发症。ISSD的病因分布在不同地区和种族间存在差异。我们旨在研究接受内镜治疗的ISSD患者的临床特征。
我们回顾性分析了2013年4月至2019年5月间所有接受内镜手术的ISSD患者。查阅患者记录，获取人口统计学数据、临床表现、内镜及影像学检查结果、手术结果和并发症情况。
共纳入37例接受手术的ISSD患者。我们根据病因将患者分为三组，包括炎症性疾病（78.4%）、肿瘤（13.5%）和自发性脑脊液（CSF）漏（8.1%）；真菌球（62.2%）是ISSD的主要病因。总体而言，最常见的症状是头痛或面部疼痛（65.5%）。血性分泌物和肿瘤病变的内镜检查结果主要来自肿瘤组。肿瘤组和脑脊液漏组的计算机断层扫描显示骨缺损更明显。磁共振成像显示肿瘤组海绵窦受累率（40.0%）和颅内扩展率（40.0%）较高。总结手术结果，成功率为97.1%，主要并发症发生率为5.4%。
ISSD病因多样，在我们地区主要为真菌球，同时仍有相当比例的ISSD归因于肿瘤和脑脊液漏。未经治疗的ISSD可导致严重并发症。我们建议对所有ISSD患者尽早进行手术干预。
