Mucocele involving the anterior clinoid process: MR and CT findings.
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We report two patients with surgically proved mucoceles involving the anterior clinoid process. One patient had a mucocele of an Onodi cell and the other had a mucocele isolated to the anterior clinoid process. The MR signal was increased on both T1- and T2-weighted images in the first patient but was isointense on both sequences in the second patient, a finding that resulted in misdiagnosis. The developmental and anatomic features, as well as the diagnostic pitfalls, are discussed. (+info)
Benign expansile lesions of the sphenoid sinus: differentiation from normal asymmetry of the lateral recesses.
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BACKGROUND AND PURPOSE: There is a wide range of normal variation is sphenoid sinus development, especially in the size of the lateral recesses. The purpose of this study was to determine imaging characteristics that may help differentiate between opacification of a developmentally asymmetric lateral recess and a true expansile lesion of the sphenoid sinus. METHODS: Coronal CT was performed in seven patients with expansile or erosive benign lesions of the sphenoid sinus, and results were compared to a control population of 72 subjects with unopacified sphenoid sinuses. The degree of asymmetry of lateral recess development was assessed with particular attention to the separation of vidian's canal and the foramen rotundum (vidian-rotundum distance). The images were also examined for evidence of: erosion, defined as loss of the normal thin bony margin on at least two contiguous sections; apparent thinning of the sinus wall, defined as a focal apparent decrease in thickness again on at least two contiguous sections; and for vidian's canal or foramen rotundum rim erosion or flattening. RESULTS: Of the seven patients with expansile lesions, vidian's canal margin erosion was present in seven, unequivocal sinus expansion in three, wall erosion in three, wall thinning in three, erosion of the foramen rotundum in two, and flattening in the foramen rotundum in four. Forty-one of the 72 controls had lateral recess formation, 28 of which were asymmetric. The distance between vidian's canal and the foramen rotundum (vidian-rotundum distance) relied on the presence or absence of pneumatization, with a significantly larger distance in the presence of greater wing pneumatization. Examination of 24 controls revealed apparent thinning of the sinus wall, typically at the carotid groove, but no flattening, thinning, or erosion of the vidian canal or of the foramen rotundum. CONCLUSION: Examination of controls and patients with expansile or erosive lesions of the sphenoid sinus revealed side-to-side asymmetry in the development of the sinus and lateral recess, making subtle expansion difficult to assess. Furthermore, variability in the vidian-rotundum distance correlated with degree of pneumatization, and did not necessarily reflect expansion. Thus, in the absence of gross sinus wall erosion, flattening or erosion of the rims of vidian's canal or the foramen rotundum provides the most specific evidence of an expansile or erosive process within the sinus. (+info)
Preoperative short-term administration of octreotide for facilitating transsphenoidal removal of invasive growth hormone-secreting macroadenomas.
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The somatostatin analog octreotide was administered prior to transsphenoidal surgery in three patients with tumors that extended to the suprasellar space and one side of the cavernous sinus. Octreotide, 100 micrograms twice a day, was subcutaneously injected for 2 weeks. Octreotide administration reduced the serum growth hormone (GH) levels in these patients from 82 to 22 ng/ml, from 148 to 12 ng/ml, and from 129 to 9 ng/ml. The tumor size shrank by about 50%, and the suprasellar extension disappeared in two patients. The main tumor was sharply dissected from the normal pituitary gland at surgery. Intracavernous portions were removed using a curette. Postoperatively, GH levels were less than 5 ng/ml in two patients, and 8.5 ng/ml in one patient. Follow-up magnetic resonance imaging revealed a small residual tumor in one side of the cavernous sinus in all patients. Follow-up GH levels were less than 5 ng/ml in one patient, and less than 2 ng/ml in two patients treated with bromocriptine. Preoperative administration of octreotide for 2 weeks reduced tumor volume and allowed near-total surgical resection of invasive macroadenomas without compromising the treatment course. Residual tumor due to intracavernous extension can be managed with bromocriptine or gamma knife radiosurgery. (+info)
A 38-year-old male presented with an extremely rare primary osteogenic sarcoma, unassociated with Paget's disease or late effects of radiation, involving the sella and sphenoid sinus region. Complete excision of the tumor was achieved through an extended frontobasal approach. Postoperatively, six cycles of combination chemotherapy (adriamycin, ifosphamide, and cisplatin) followed by a total of 55 Gy local radiotherapy in 33 fractions was given. Primary osteogenic sarcoma should be considered in the differential diagnosis of the central skull base tumors. Osteogenic sarcoma, in general, has a bad prognosis, and should be managed aggressively with multimodality treatment including gross total surgical resection, combination chemotherapy, and radiotherapy. (+info)
Cavernous sinus syndrome associated with nonsecretory myeloma.
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The case of a 53-year-old man who developed cavernous sinus syndrome (CSS) four years after being diagnosed as having nonsecretory myeloma is described. He was admitted with diplopia and dull pain over the right infraorbital and zygomatic region in June 1997. The cause of CSS was the intracranial involvement of myeloma, which was diagnosed by fiberscopic biopsy. The results of endocrinologic evaluation were almost normal. The response to radiotherapy and chemotherapy was mild. CSS caused by nonsecretory myeloma is rare and its prognosis is poor. More aggressive chemotherapy with stem cell support may be indicated. (+info)
Age-related expansion and reduction in aeration of the sphenoid sinus: volume assessment by helical CT scanning.
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BACKGROUND AND PURPOSE: Aeration of the sphenoid sinus expands with the development of the sphenoid bone, but scant detailed volumetric data regarding this process, as it evolves from childhood to old age, exist. Using helical CT scanning, we assessed age-related volumetric changes of the sphenoid sinus. METHODS: We used CT data obtained from 214 patients (age range, 1 to 80 years; 111 male and 103 female subjects) with middle or inner ear disease to assess the extent of sphenoid aeration. We also determined volumes of the sphenoid sinuses on 1.0- or 1.5-mm reformatted images by integrating the sinus air (< or = -900 HU) area. RESULTS: Sphenoid sinus aeration began as a doublet in the anterior boundary of the sphenoid bone by the age of 5 years, with patients more than 6 years old exhibiting varying degrees of aeration. The aeration on both sides continued to expand until the third decade of life. The maximum average volume was 8.2 +/- 0.5 cm3. Thereafter, the volume decreased gradually, with the average volume in the seventh decade of life being 71% of the maximum level. The aeration of the peripheral portions of the sphenoid bone, such as the pterygoid process, anterior clinoid process, and dorsum sella, occurred predominantly after closure of the spheno-occipital suture, and showed a tendency to recede during aging. CONCLUSION: Volumetric assessment of the sphenoid sinus by helical CT scanning revealed age-related expansion and reduction in aeration. (+info)
A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings.
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BACKGROUND AND PURPOSE: The sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. We undertook this study to evaluate the potential etiopathogenesis of spontaneous CSF fistula involving the sphenoid sinus and to review the imaging findings. METHODS: We retrospectively reviewed the imaging findings of 145 cases of CSF fistula from our departmental archives (August 1995 through August 1998). Fifteen (10%) patients had CSF fistulas involving the sphenoid sinus. Eleven (7%) patients had spontaneous CSF fistulas, whereas in four patients, the CSF fistulas in the sphenoid sinus were related to trauma. Of the 11 patients, nine underwent only plain high-resolution CT and MR cisternography. One patient additionally underwent contrast-enhanced CT cisternography, and one other patient underwent MR cisternography only. For each patient, the CSF fistula site was surgically confirmed. The MR imaging technique included T1-weighted and fast spin-echo T2-weighted 3-mm-thick coronal sequences obtained with the patient in the supine position. The plain high-resolution CT study included 3-mm-thick, and sometimes 1- to 1.5-mm-thick, coronal sections obtained with the patient in the prone position. Similar sections were obtained after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. We evaluated each of the 11 patients for the exact site of CSF leak in the sphenoid sinus. We also determined the presence of pneumatization of lateral recess of the sphenoid sinus, orientation of the lateral wall of the sphenoid sinus, presence of arachnoid pits, presence of brain tissue herniation, and presence of empty sella in each of these patients. RESULTS: The exact sites of the CSF fistulas were documented for all 11 patients by using plain high-resolution CT, MR cisternography, or CT cisternography. In nine (82%) patients, the sites of the CSF fistulas were at the junction of the anterior portion of the lateral wall of the sphenoid sinus and the floor of the middle cranial fossa. In the remaining two (18%) patients, the sites of the CSF fistulas were along the midportion of the lateral wall of the sphenoid sinus. Of these 11 patients, one had bilateral sites of the CSF fistula at the junction of the anterior portion of the lateral wall of the sphenoid sinus with the floor of the middle cranial fossa. In nine (82%) patients, the presence of brain tissue herniation was revealed, and this finding was best shown by MR cisternography. Ten (91%) patients had extensive pneumatization of the lateral recess of the sphenoid sinus, with an equal number having outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus. In seven (63%) patients, the presence of arachnoid pits, predominantly along the anteromedial aspect of the middle cranial fossa, was shown. In seven (63%) patients, empty sella was shown. For comparison, we reviewed the CT studies of the paranasal sinuses in 100 age-matched control subjects from a normal population. Twenty-three had extensive lateral pneumatization of the sphenoid sinus along with outward concavity of the inferior portion of the lateral wall. None of these 23 patients had arachnoid pits. CONCLUSION: The sphenoid sinus, when implicated as a site of spontaneous CSF leak, yields a multitude of imaging findings. These are extensive pneumatization of the lateral recess of the sphenoid sinus, outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus, arachnoid pits, and empty sella. Considering the normative data, we speculate that this constellation of findings could play a role in the etiopathogenesis of spontaneous sphenoid sinus fistulas. Our findings also show the efficacy of noninvasive imaging techniques, such as plain high-resolution CT and MR cisternography, in the evaluation of sphenoid sinus CSF leak. Our data also suggest that spontaneous sphenoid sinus CSF leak is not an uncommon occurrenc (+info)
A case of optic neuropathy treated by percutaneous trans-coronary angiography.
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There are many risk factors involved in the development of ischemic optic neuropathy such as diabetes mellitus, hypertension, arteriosclerosis, and vascular incompetence. Therefore, the treatment of ischemic optic neuropathy should not be solely based on proper diagnosis but should also involve a thorough and systemic investigation to identify those multifactorial possibilities, which may contribute to the pathogenesis of the disease. We report upon a patient who developed non-arteritic ischemic optic neuropathy following treatment of a sphenoethmoid mucocele, which lead to recovered vision and a satisfactory improvement of visual field defects, after percutaneous trans-coronary angiography with stent insertion of the coronary arteries. (+info)