Herman P, Lot G, Guichard J P, Marianowski R, Assayag M, Tran Ba Huy P
Department of Otolaryngology, Hôpital Lariboisière, Paris, France.
Ann Otol Rhinol Laryngol. 1998 Sep;107(9 Pt 1):765-8. doi: 10.1177/000348949810700905.
In an 18-month period, 3 cases of sphenoidal mucocele following pituitary surgery were diagnosed at our institution. Only 1 case of this late-onset disorder has yet been reported as a pitfall of the transsphenoidal route. Symptoms include recurrent headache and visual complications. Diagnosis was delayed because of misinterpretation of the magnetic resonance imaging findings, which actually showed the development of a sphenoid mucocele long before clinical symptoms occurred. These 3 cases suggest that attention should be focused not only on the sella turcica, but also on the sphenoid sinus, in analyzing the magnetic resonance imaging data. The treatment consists of endoscopic transnasal marsupialization, since the mucocele is lined by normal epithelium with an inflammatory reaction that will heal with drainage. At the time of surgery, prevention would require either endoscopic control of the mucosal remnants, in case of sinus exclusion, or leaving the sphenoid sinus air-filled under a sealed sella.
在18个月的时间里，我院诊断出3例垂体手术后发生的蝶窦黏液囊肿。这种迟发性疾病仅有1例曾作为经蝶窦入路的一个陷阱被报道过。症状包括复发性头痛和视觉并发症。由于对磁共振成像结果的误判，诊断被延误，而实际上在临床症状出现很久以前，磁共振成像就显示出蝶窦黏液囊肿的形成。这3例病例表明，在分析磁共振成像数据时，不仅应关注蝶鞍，还应关注蝶窦。治疗方法为内镜经鼻造袋术，因为黏液囊肿内衬正常上皮并有炎症反应，引流后可愈合。手术时，预防措施要么是在鼻窦封闭的情况下通过内镜控制黏膜残余，要么是在密封的蝶鞍下使蝶窦保持充气状态。
