The endoscopic management of sphenoid and ethmoid mucoceles with orbital and intranasal extension

Mucoceles of the sphenoidal and ethmoidal sinuses act as benign neoplasms and can result in bony erosion extending from within the confines of the sinuses into the intracranial and orbital spaces. Endoscopic management of such mucoceles has been debated, and, by some, considered a radical form of therapy. A review of consecutive patients with sinus mucoceles revealed eight sphenoid and six ethmoid mucoceles. Four of these were confined to the sinuses and 11 extended outside of the confines of the sinuses. There were four with intracranial extension, two with orbital extension, three with both intracranial and orbital extension, and two involving the clivus. All 15 patients were managed with endoscopic decompression. Two patients with ethmoid-frontal mucoceles also had frontal sinus obliteration, via an osteoplastic flap along with sphenoethmoidal decompression with an endoscopic approach. Thirteen patients had more than one year of follow-up. Two patients with ethmoid mucoceles with intracranial extension had recurrences of the mucoceles which again have been decompressed endoscopically. There were no orbital or intracranial complications in relationship to these procedures or from the mucoceles. Symptoms related to the mucoceles including loss of vision and severe headaches were resolved with decompression. The endoscopic management of sphenoid and ethmoid mucoceles with orbital and intracranial extension is a safe and reliable approach, obviates the need for major intracranial surgery and diminishes post-operative morbidity. Close follow-up is necessary and secondary decompression can be accomplished should the mucocele recur.