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Isolated sphenoid sinus fungal mucoceles: A rare entity with a high propensity for causing neurological complications
Marwa Ibrahim1,2, Marwan Alqunaee3, Mustafa Najibullah4
1Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Background:
Isolated sphenoid sinus fungal mucoceles are extremely rare and potentially associated with visual disturbances, cranial nerve (CN) deficits, or pituitary dysfunction. Their initial symptoms are often absent or nonspecific, and routine examination offers little information, resulting in diagnostic and therapeutic delays. A high index of suspicion and a thorough understanding of their clinical presentation, neuroradiological features, microbiological implications, and complication profile are crucial for early diagnosis and prompt management. We, herein, analyze a series of consecutive cases of isolated sphenoid sinus fungal mucoceles whom we treated, add to the currently existing published cases, and review the pertinent literature.
Methods:
From the databases of endoscopic endonasal skull base and rhinological surgical procedures maintained by our groups, all cases with isolated sphenoid sinus fungal mucoceles were retrieved and included in the study. Clinical and radiological findings, histopathologic evidence of fungal rhinosinusitis, culture results, clinicopathological designation, treatment details, and outcome of CN neuropathies were analyzed.
Results:
Headache was the most common symptom (seven cases). Oculomotor (three cases) and abducens (two cases) nerve palsies were encountered in five out of eight patients. Visual loss was seen in two cases. Hypopituitarism was seen in one case. All patients underwent endoscopic endonasal wide bilateral sphenoidectomy. CN palsies improved in four out of five cases.
Conclusion:
Endoscopic endonasal wide sphenoidectomy is the surgical treatment of choice and should be performed in a timely manner to prevent permanent sequelae. Histopathological and microbiological examination findings should both be obtained as they dictate the next steps of therapeutic intervention.
Insights
Isolated sphenoid sinus fungal mucoceles are rare but can cause serious neurological issues. Prompt endoscopic surgery is key to recovery and preventing permanent damage.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pathology
Background:
- Isolated sphenoid sinus fungal mucoceles are rare and often present with nonspecific symptoms, leading to diagnostic delays.
- Potential complications include visual disturbances, cranial nerve deficits, and pituitary dysfunction.
- Early diagnosis requires a high index of suspicion and understanding of clinical, radiological, and microbiological features.
Purpose of the Study:
- To analyze a series of treated cases of isolated sphenoid sinus fungal mucoceles.
- To review the existing literature on this rare condition.
- To highlight the importance of prompt diagnosis and management.
Main Methods:
- Retrospective analysis of cases undergoing endoscopic endonasal skull base surgery.
- Inclusion criteria: isolated sphenoid sinus fungal mucoceles.
- Data collected: clinical, radiological, histopathological, microbiological findings, treatment, and outcomes.
Main Results:
- Headache was the most common symptom.
- Cranial nerve palsies (oculomotor, abducens) occurred in 5/8 patients, with improvement in 4/5 after surgery.
- Visual loss and hypopituitarism were also observed.
Conclusions:
- Endoscopic endonasal wide sphenoidectomy is the treatment of choice for timely management.
- Histopathological and microbiological findings are crucial for guiding further therapeutic interventions.
- Prompt surgical intervention can prevent permanent sequelae.
