Sphenoid Sinus Mucocele with Unilateral Abducent Nerve Palsy and Visual Loss: A Case Report

蝶竇黏液囊腫合併單側外展神經麻痺及視力喪失－病例報告

陳清龍(Ching-Long Chen) ； 劉祥耀(Hsiang-Yao Liu) ； 吳劍男(Jian-Nan Wu) ； 王騰毅(Teng-Yi Wang) ； 呂大文(Da-Wen Lu)

《中華民國眼科醫學會雜誌》 45卷2期 (2006/06) Pp. 109-113

https://doi.org/10.30048/ACTASOS.200606.0007

摘要

目的：報告一例因罹患蝶竇黏液囊腫而導致單側外展神經麻痺及視力喪失的病例。
方法：病例報告。
結果：一位60歲女性糖尿病患者，因左側外展神經麻痺至眼科求診，此時無明顯視力損傷（雙眼最佳矯正視力：6/6）。接著患者開始覺得左眼視力逐漸模糊，四個月後檢查時，患者左眼已無光感。電腦斷層及核磁共振影像檢查顯示蝶竇有一囊狀病兆，懷疑為蝶竇黏液囊腫。經耳鼻喉科評估後實施功能性鼻竇內視鏡手術同時作視神經減壓術，術後七日，病人左眼最佳矯正視力進步為6/6.7，但左眼顯側及下鼻側仍有部分視野缺損且左側外展神經麻痺依舊。
結論：蝶竇黏液囊腫是一不常見且不易診斷的疾病，常須待壓迫周邊組織產生症狀後，才能被診斷出來。由於它在我們眼科的臨床表現可以是外展神經麻痺及逐漸視力喪失，因此應將它列入鑑別診斷。惟有早期診斷及手術治療，其所導致的外展神經麻痺及視力喪失才有可能完全恢復。

並列摘要

Purpose: Here we examine a case of sphenoid sinus mucocele presenting with left abducens nerve palsy and subsequent loss of left eye vision.
Method: Case report
Results: A 60-year-old diabetic female presented initially with left abducens nerve palsy. However, four months later, complete visual loss was noted in her left eye. Computed tomography and magnetic resonance imaging revealed paranasal sphenoid sinus mucocele. The patient's symptoms resolved following an emergency functional endoscopic sinus surgery combined with optic nerve decompression. On the seventh day after the operation, her visual field of the left eye showed only minor temporal and inferonasal scotoma and the best corrected visual acuity in her left eye was recovered to 6/6.7. However, the abduction of her left eye was still impaired.
Conclusion: We show here that sphenoid sinus mucocele can simulate a variety of pathological conditions. With early diagnosis and prompt surgical intervention, the sphenoid sinus mucocele-associated neurological deficits can be restored completely.

並列關鍵字

Abducens nerve ； optic nerve ； sphenoid sinus ； mucocele