侵犯海綿靜脈竇之原發性蝶竇黏液囊腫

Primary Sphenoid Sinus Mucocele with Extension into the Cavernous Sinus

陳約廷(Yueh-Ting Chen) ； 葉啟偉(Chi-Wei Yeh)

《北市醫學雜誌》 2卷5期 (2005/05) Pp. 481-484

https://doi.org/10.6200/TCMJ.2005.2.5.09

摘要

鼻竇黏液囊腫是鼻竇病變中偶見之疾病，不易早期診斷，病例有一半以七從症狀出現到診斷出來超過一年，但不論原發性或續發陸，多位於額竇、篩竇或上頷竇。蝶竇黏液囊腫則少見。本院於2002年7月經歷一名64歲女性患者，於神經內科主述右側頭痛及短暫之姿勢性眩暈，腦部電腦斷層檢查診斷為大腦萎縮及小腦椎底動脈粥狀硬化並出現急速惡化之複視、劃則眼瞼下垂，核磁共振攝影發現了蝶竇均質腫塊，馴腫塊效應壓迫到海綿靜脈竇。於是會診本科後立即實施內視鏡蝶竇均質腫塊前壁摘除術及引流。視力及動眼肌功能淤手術十天後完全恢復正常，術後追蹤至今，並無復發現象。

關鍵字

蝶竇 ； 黏液囊腫 ； 內視鏡手術

並列摘要

Sphenoid sin us mucocele is a rare entity (1% to 2% of paranasal sinus mucoceles) and difficult to diagnose. Due to the numerous important anatomical structures nearby, it can cause a variety of symptoms, among which headache and visual abnormalities are the most important. In July 2002, we treated a 64-year- old female. Her symptoms were right hemicrania and episodic postural dizziness. The brain CT scan showed brain atrophy and atherosclerosis of the bilateral internal carotid and basilar arteries. She was subsequently admitted to our Neurology ward. However, the next day she showed exacerbated symptoms with right sided diplopia and ptosis with blurred vision. An emergent MRI was performed showing a huge homogenous sphenoid sinus mass, which was expanding outside the sphenoid sinus putting pressure on the pituitary gland and the cavernous sinus. The Neurology Department then consulted our Department and we immediately performed endoscopic surgery. In surgery, the anterior wall of the sphenoid sinus was removed and mars upialization was performed, whereby much yellowish mucopus was drained. The symptoms of headache and visual abnormalities disappeared ten days after surgery and no evidence of recurrence has been noted since.

並列關鍵字

sphenoid sinus ； mucocele ； endoscopic surgery