Yoshida Haruo, Kihara Chiharu, Kumai Yoshihiko
Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Craniofac Surg. 2023;34(5):e503-e505. doi: 10.1097/SCS.0000000000009377. Epub 2023 Jun 1.
A 59-year-old man, who had a history of left blind at 36 years old, suddenly lost right visual acuity. Magnetic resonance imaging revealed a large left sphenoid sinus cyst, which protruded intracranially. The cyst was fenestrated by endoscopic sinus surgery, but his right vision did not recover. Ten cases of bilateral rhinogenous optic neuropathy caused by mucocele have been reported, and the cause was sphenoid sinus in 9 cases. Postoperative visual acuity in these cases was poor, especially in slow progressive cases, because it was diagnosed as an unknown cause, and surgery was delayed. Rhinogenous optic neuropathy caused by mucocele should be differentiated from bilateral visual impairment of unknown cause. The authors highlight the importance of early diagnosis of sphenoid sinus mucocele and fully informing patients about the future risk of bilateral visual impairment, even if they are asymptomatic or have been treated.
一名59岁男性，36岁时左眼失明，现突然右眼视力丧失。磁共振成像显示左侧蝶窦有一个巨大囊肿，向颅内突出。通过鼻内镜鼻窦手术对囊肿进行了开窗，但他的右眼视力并未恢复。已有10例黏液囊肿引起双侧鼻源性视神经病变的病例报道，其中9例病因是蝶窦。这些病例术后视力较差，尤其是在病情进展缓慢的病例中，因为最初被诊断为病因不明，手术被延迟。黏液囊肿引起的鼻源性视神经病变应与病因不明的双侧视力损害相鉴别。作者强调了早期诊断蝶窦黏液囊肿的重要性，并充分告知患者即使无症状或已接受治疗，仍存在双侧视力损害的未来风险。
