Search Results (107)

Background: Invasive aspergillosis with orbital apex and intracranial involvement is rare and often misdiagnosed due to nonspecific imaging findings. Misinterpretation may lead to inappropriate therapies, such as corticosteroids, which can exacerbate fungal infections. Case Presentation: A 50-year-old immunocompetent woman with diabetes mellitus presented with right ptosis and systemic malaise. Magnetic resonance imaging (MRI) performed three months prior had shown a subtle low-signal lesion in the right orbital apex. The lesion was small and thought to represent a granulomatous process, with minimal systemic inflammation and only mild surrounding changes on imaging. Biopsy was considered too invasive at that stage, and the patient was placed under observation. Over time, her condition progressed, and repeat imaging revealed intracranial extension, including involvement of the cavernous sinus and frontal lobe. Differential diagnoses included granulomatous diseases such as sarcoidosis or tuberculosis, prompting empirical anti-tuberculosis treatment. However, the patient’s condition worsened, and biopsy of the sphenoid sinus revealed septated fungal hyphae consistent with Aspergillus species on Grocott staining. Voriconazole therapy was initiated, resulting in significant clinical and radiological improvement. Discussion: This case highlights the diagnostic challenge of identifying orbital apex aspergillosis with early MRI changes and demonstrates the risk of misdiagnosis as granulomatous disease. Differentiating fungal infections from other inflammatory etiologies based on subtle imaging features is critical, especially when considering immunosuppressive therapy. Conclusion: Clinicians should maintain a high index of suspicion for fungal infections in patients with progressive orbital apex lesions, even in the absence of classic immunosuppression. Early imaging review and biopsy are essential to prevent misdiagnosis and inappropriate treatment. Full article

Background: Cholesteatoma, characterized by the abnormal growth of keratinizing squamous epithelium in ectopic locations, most commonly arises in the middle ear. Its occurrence in the sinonasal tract is rare and presents significant diagnostic and management challenges. These lesions can lead to severe complications like bone erosion, intracranial involvement, and orbital spread. This narrative review aims to summarize the current knowledge on cholesteatomas in these regions, focusing on epidemiology, pathophysiology, diagnosis, and treatment. Methods: A comprehensive review of the English literature was conducted, focusing on reported cases of cholesteatomas in the nasal cavity and paranasal sinuses. This review examines key aspects, including epidemiological data, imaging findings, surgical strategies, and postoperative outcomes. The role of diagnostic tools, particularly computed tomography and diffusion-weighted magnetic resonance imaging, in distinguishing cholesteatomas from other sinonasal lesions is also discussed. Results: As of March 2025, 51 cases of paranasal sinus cholesteatoma were reported. The frontal sinus is the most commonly affected site, followed by the maxillary, ethmoid, and sphenoid sinuses. Diagnosis is often delayed due to nonspecific symptoms, such as nasal congestion and recurrent infections. Surgical excision is the primary treatment, with endoscopic techniques being favored for their minimally invasive nature. Recurrence remains a major concern, and although very rare, cases of squamous cell carcinoma have also been observed in association with cholesteatoma. Conclusions: Nasal and paranasal sinus cholesteatomas require early recognition and intervention to prevent complications. Advances in imaging and surgery have improved outcomes; however, further research is needed to refine therapies and understand disease mechanisms. Full article

Objectives: The aim of the present study was to examine the growth dynamics of the ossification centers of the lesser wings of the sphenoid bone in the human fetus based on linear, planar, and volumetric parameters. Methods: The examinations were carried out on 37 human fetuses of both sexes (16 males and 21 females) after 18–30 weeks of gestation. These were obtained from spontaneous miscarriages and preterm deliveries. Using computed tomography (CT), digital image analysis software, 3D reconstruction, and statistical methods, the size and growth patterns of the ossification centers of the lesser wings of the sphenoid bone were evaluated. Results: All morphometric parameters—length, width, projected surface area, and volume—of the ossification centers of the lesser wings of the sphenoid bone increased proportionally with gestational age. No significant sex-related or lateral differences were observed. Conclusions: The numerical data obtained from CT-based analysis and the observed growth trends of the ossification centers of the lesser wings of the sphenoid bone may serve as age-specific normative references. These findings may support clinicians—including anatomists, radiologists, obstetricians, pediatricians, and craniofacial surgeons—in the assessment of normal fetal cranial development and the early diagnosis of congenital craniofacial anomalies. Full article

Background: Sphenoiditis poses diagnostic and treatment challenges due to its complex anatomy and potential for serious complications. Anatomic variations, such as Onodi cells, could play a role in the onset and spreading of inflammation. The diagnosis and treatment of sphenoiditis can be more difficult if Onodi cells are present, especially due to their proximity to delicate vital tissues. Objectives: The purpose of this study was to look at the frequency, features, and relationship between Onodi cells and sphenoiditis. Methods: This multicentric study comprised 550 people who received sinonasal CT imaging. The Thimmaiah classification was used to assess the presence and features of Onodi cells, and radiographic results were used to diagnose sphenoiditis. We conducted univariate and multivariate logistic regression to evaluate the relationships between sphenoiditis and Onodi cells. Results: The prevalence of Onodi cells was 32.40%, with a higher prevalence on the right side (18.40%) compared to the left side (8.40%). The multivariable analysis revealed a significant correlation between right-side Type II Onodi cells and a higher incidence of sphenoiditis (OR = 6.81, 95% CI: 1.14–38.97, p = 0.029). In the univariable analysis (OR = 3.00, 95% CI: 1.15–6.96, p = 0.015), but not in the multivariable analysis, the presence of Type I Onodi cells on the left side was significantly associated with sphenoiditis. Conclusions: There may be a link between a higher incidence of sphenoiditis and the presence of Type II Onodi cells on the right side. In order to validate these findings and clarify the underlying processes of this connection, more prospective research is required. Full article

The study aimed to analyze hsa-miR-16-5p, hsa-miR-143-3p, hsa-miR-423-5p, hsa-miR-137-3p, hsa-miR-489-5p, hsa-miR-520-3p, hsa-miR-486-5p, and hsa-miR-200a-3p expression in the serum of patients with invasive non-functioning pituitary adenomas (NFPAs) and prolactinomas, as candidates for non-invasive biomarkers. The study included 62 patients with NFPAs and 18 with macroprolactinoma who qualified for transsphenoidal surgical resection. MicroRNAs were isolated from serum samples. The expression levels of hsa-miR-16-5p, hsa-miR-143-3p, hsa-miR-423-5p, hsa-miR-137-3p, hsa-miR-489-5p, hsa-miR-520-3p, hsa-miR-486-5p, and hsa-miR-200a-3p were determined using TaqMan MicroRNA assays. The statistical analyses were performed with MedCalc. The total concentration of microRNA was significantly lower in NFPAs than in the CG (p = 0.0419). ROC curve analysis showed that the cutoff point of miRNA lower than 10.73 predicted the PA (sensitivity = 70.0%; specificity = 57.7%; AUC = 0.629; p = 0.052). No correlation between selected miRNAs and tumor type was found: hsa-miR-143-3p (p = 0.4610), hsa-miR-16-5p (p = 0.8767), and hsa-miR-423-5p (p = 0.1459). miRNA expression also did not correlate with invasiveness (cavernous or sphenoid sinus invasion, optic chiasm compression). Although the total expression of microRNA was significantly lower in NFPAs, hsa-miR-16-5p, hsa-miR-143-3p, and hsa-miR-423-5p are not useful as non-invasive biomarkers in patients with invasive non-functioning pituitary adenomas and prolactinomas. Full article

Chronic fungal sinusitis (FS) can cause bone erosion and extend to the sellar region, often misdiagnosed as pituitary tumors or malignancies. We report a 56-year-old immunocompetent female with sphenoid FS presenting as a giant sellar mass compressing the optic chiasm, with normal pituitary function. The surgery successfully resolved her symptoms, and a histological examination confirmed the presence of a fungal hyphal mass. We conducted a literature review of 52 publications on FS cases with bone erosion and inflammatory extension to the sellar region, which included analyses of 67 patients (35 females, mean age 49.6 years, half immunocompetent). The most common symptom was headache (73.1%), followed by visual complaints (71.7%), visual deterioration (40.3%), ophthalmoplegia (38.8%), and visual field defects (13.4%). Symptom duration averaged 4.5 months in 65.7% of cases. Aspergillus was the most frequent (71.6%). Hormonal abnormalities included hypopituitarism (25.4%) and hyperprolactinemia (13.4%). Surgery was performed in 92.5% of patients. Common diagnoses included pituitary abscess (41.8%), fungal granuloma (16.4%), aspergillosis (16.4%) and allergic FS (14.9%). Antifungal therapy was administered in 53.7% of cases. Cure was achieved in 67.2%, while the mortality rate was 10.4%. Early recognition of fungal involvement, supported by a multidisciplinary approach, is essential for the accurate diagnosis and effective treatment. This highlights the need for vigilance to improve the outcomes in similar cases. Full article

Skull base meningiomas present considerable challenges in surgical management due to their proximity to critical neurovascular structures. Anterior skull base meningiomas encompass olfactory groove, supra- and parasellar, anterior sphenoid ridge, cavernous sinus, and spheno-orbital tumors. The success of surgical resection and the likelihood of complications are influenced by several key factors, including the presence of an intact arachnoid plane, tumor size and consistency, peritumoral brain edema, cranial nerve involvement, vascular encasement, and invasion of critical areas such as the optic canal or cavernous sinus. These factors not only affect the feasibility of gross total resection but also play a pivotal role in determining functional outcomes and postoperative recovery. With the vast array of imaging modalities available, selecting the most appropriate investigations to assess these parameters and tailoring surgical strategies accordingly remain complex tasks. This review examines the critical surgical parameters, identifies the most effective imaging modalities for evaluating each, and provides key insights into how this analysis can guide surgical decision-making, mitigate risks, and minimize complications. Full article

Background/Objectives: Brown tumors are rare bone lesions associated with hyperparathyroidism, particularly secondary hyperparathyroidism (SHPT), in chronic renal failure. While brown tumors commonly affect bones rich in marrow, the involvement of the sphenoid sinus is extremely rare and can present with neurological symptoms. This study reports a case of a sphenoid sinus brown tumor in a patient on hemodialysis, highlighting its clinical presentation and diagnostic challenges. Methods: A 31-year-old woman undergoing chronic hemodialysis presented with a severe headache, diplopia, and progressive vision loss in her left eye. Laboratory tests revealed hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH) levels, consistent with SHPT. The diagnosis was confirmed through a clinical examination and magnetic resonance imaging (MRI). Results: The clinical examination confirmed decreased visual acuity in the left eye. The laboratory results revealed serum calcium of 15.5 mg/dL, phosphate of 1.0 mg/dL, and PTH of 2000 pg/mL, consistent with SHPT. The imaging studies identified a brown tumor in the sphenoid sinus exerting a mass effect on adjacent structures. This case underscores the rarity of brown tumors in this location, with very few similar reports in the literature. Conclusions: Although rare, brown tumors should be considered in patients with SHPT who present with neurological symptoms or cranial lesions. An early diagnosis through biochemical and imaging studies is crucial to prevent severe complications. The management involves treating the underlying hyperparathyroidism, with surgical intervention indicated in cases of neural compression. Full article

Alveolar rhabdomyosarcoma (aRMS) is a rare pediatric malignant tumor with a poor prognosis, particularly when located in the rhinopharynx and sphenoidal floor, which complicates diagnosis and increases the risk of misclassification as benign growths. The specific genotype of aRMS is associated with a worse clinical outcome. In young children, especially those aged 4 to 12 years, rhinopharyngeal masses are often attributed to chronic adenoiditis; however, other benign (e.g., angiofibroma in boys) and malignant tumors may also be present. Initial symptoms frequently include nasal obstruction, muco-purulent nasal discharge, serous otitis media, sinusitis, and epistaxis. Rhabdomyosarcoma is the second most common ENT neoplasm in children, following lymphoma, with an incidence of approximately 6 cases per 1,000,000 annually. This report presents the case of an 8-year-old boy diagnosed with aRMS, accompanied by a literature review. Alveolar rhabdomyosarcoma should be suspected in children presenting with a vegetative tumor in the rhinopharynx or paranasal sinuses. Combined treatment approaches (surgery, radiotherapy, and chemotherapy) should be tailored to tumor characteristics. Neuronavigation-guided functional endoscopic sinus surgery (FESS) is an effective option for achieving complete tumor excision, depending on tumor size and extent. The prognosis remains reserved and is contingent upon accurate evaluation and timely intervention. Rigorous follow-up, including endoscopic and imagistic investigation, is crucial for early detection of recurrences, thereby improving treatment outcomes. Full article

Ventriculo-meningitis or nosocomial meningitis/ventriculitis is a severe nosocomial infection that is associated with devastating neurological sequelae. The cerebrospinal fluid isolates associated with the infection can be Gram-positive or -negative, while the Enterococcus spp. is rarely identified. We report a case of a 68-year-old woman with a past medical history of insulin-dependent diabetes mellitus, hypertension, and coronary artery disease. She was admitted to the intensive care unit following a scheduled sphenoid wing meningioma resection. Her course was complicated with left middle cerebral artery pseudoaneurysm and hemispheric hemorrhage, and an arterial stent and external ventricular drainage catheter were placed. Neurological evaluation showed a minimal conscious state. She presented high fever on the 35th intensive care unit day. Cerebrospinal fluid was sampled and the external ventricular catheter was removed. Enterococcus faecalis was isolated from the culture specimen. The patient received targeted treatment with an ampicillin plus ceftriaxone combination, and a follow-up culture confirmed the pathogen’s eradication. Although she was considered cured, she had a prolonged intensive care unit stay and finally died in the ward two months after the completion of treatment. This case highlights the first reported use of this combination in a severe, non-endocarditis, invasive enterococcal infection, while the review discusses treatment options for nosocomial ventriculitis/meningitis. Full article

Background: Sphenoid wing meningiomas (SWM) frequently compress structures of the optic pathway, resulting in significant visual dysfunction characterized by vision loss and visual field deficits, which profoundly impact patients’ quality of life (QoL), daily activities, and independence. The objective of this study was to assess the impact of SWM surgery on patient-reported outcome measures (PROMs) regarding postoperative visual function. Methods: The Visual Function Score Questionnaire (VFQ-25) is a validated tool designed to assess the impact of visual impairment on quality of life. The questionnaire was distributed to a previously published study population in which shape radiomics were correlated with new cranial nerve deficits after SWM surgery. Results: A total of 42 patients (42/74; 56.8%) responded to the questionnaire. Of the 42 patients, 30 were female (71%) and 12 were male (29%). The multivariable analysis demonstrated that lower sphericity reflecting irregular SWM shape was associated with poorer VFQ-25 (OR: 6.8, 95% CI: 1.141.8, p = 0.039), while age was associated with lower VFQ-25 (OR: 27, 95% CI: 2.7−272.93, p = 0.005), too. Analysis of the subcategories of the VFQ-25 revealed significantly reduced general vision (p = 0.045), social functioning (p = 0.045), and peripheral vision (p = 0.017) in those with SWM with low sphericity. Conclusions: The study highlights that SWM surgery impacts postoperative visual function, with age and irregular SWM shape being associated with poorer postoperative VFQ-25 scores. VFQ-25 is a feasible tool to assess vision outcome in SWM surgery and has clinical potential for longitudinal follow-up evaluations. Irregular SWM shape should be considered during preoperative treatment planning and patient consultation regarding functional outcome. Full article

Background/Objectives: This study aims to investigate the three-dimensional morphological differences of the sphenoid sinus according to sex in the Korean adult population and conduct an exploratory study based on the findings. The sphenoid sinus, located deep within the skull, plays a crucial role in forensic identification due to its relative protection from external damage and its unique anatomical characteristics. Methods: Using cone-beam computed tomography (CBCT) data from 120 patients (60 males and 60 females) aged 20–29, the sphenoid sinus was visualized and measured in three dimensions using Mimics software (version 22.0). Measurements included the volume of the sphenoid sinus, as well as its dimensions in the X, Y, and Z axes. The measured data were analyzed using SPSS (version 23.0) with a t-test and linear regression analysis. Results: The results showed that the sphenoid sinus volume was significantly larger in males compared to females (p < 0.05), with an average male sinus volume of 16,957.9 mm³ and a female volume of 13,517.7 mm³. Additionally, the X-width, Y-width, and Z-width were all larger in males, with significant differences (p < 0.001) across all dimensions. Further regression analysis revealed that the volume of the sphenoid sinus was primarily influenced by the Z-axis height (measured from the coronal view) and the Y-axis width (measured from the sagittal view), while the X-axis width had a negligible effect on the overall volume. Conclusions: These findings suggest that sex-specific differences in the sphenoid sinus may provide important insights for clinical diagnoses and forensic personal identification. This study highlights the need for further research on different age groups and ethnic populations to enhance the understanding of anatomical variations in the sphenoid sinus and their potential applications in both medical and forensic fields. Full article

Objectives: In pituitary adenomas, examinations of surgical specimens have shown that dural invasion occurs in 42–85% of cases. No studies about dura mater invasion have been conducted specifically in acromegaly patients. The aim of the present study was to evaluate the relationship between histologically dural invasion and the main features of GH-secreting adenomas. Methods: This retrospective study included all consecutive acromegaly patients who underwent neurosurgery at our university hospital between 2017 and 2020. The following data were collected: (1) clinical, biochemical and morphological data at diagnosis, at three months, one year after neurosurgery, and at last follow-up; (2) pathological features (dura mater invasion, immunohistochemical analyses, proliferation index Ki-67, p53, and granulation pattern); and (3) radiological features on magnetic resonance images. Results: Of 35 acromegaly patients, 11 had dural invasion (INV+ 31%) and 24 did not (INV− 69%). GH levels at diagnosis were greater in INV+ patients (p = 0.02), and a GH value > 27 ng/mL was able to distinguish INV+ patients (Sensitivity 80%, Specificity 73%, AUC 0.760, p = 0.006). Indeed, patients with GH > 27 ng/mL at diagnosis had a tenfold greater risk of dura mater invasion (OR 10.7; 95% CI 1.74–65.27, p = 0.005). No differences were found in the other clinical, biochemical, morphological, radiological and pathological features. Regarding remission likelihood, IGF-1 levels at diagnosis were lower in cured patients (p = 0.03). Conclusions: The GH level at diagnosis is the only parameter significantly associated with dura mater invasion. Lower IGF-1 levels at diagnosis are significantly associated with remission one year after surgery. Full article

The lateral pterygoid muscle (LPM), a critical component of the masticatory muscles, typically comprises upper (SLPM) and lower (ILPM) heads. However, it is essential to note that the LPM’s structure is not a constant feature, as the number of bundles and their topography can vary. Moreover, additional heads, such as medial and middle heads, and unique-headed configurations of the LPM have been reported. Several studies have demonstrated the penniform structure of the LPM, which is further supported by its diverse pattern of innervation. Anatomically, the LPM originates from the greater wing and lateral pterygoid plate of the sphenoid bone, with variations in these origins being common. For instance, the presence of a broad lateral pterygoid plate or extensions from it can enlarge the origin area of the LPM. Equally variable are the insertions of the LPM, which can include attachments to the mandibular condyle and the temporomandibular joint disc. In some cases, aberrant LPM bundles may attach to the mandibular condyle outside the mandibular notch. Rarely encountered muscles like the pterygoideus proprius, pterygospinosus, and pterygofacialis further add to the diversity of this muscle. The anatomy of the LPM is subject to modification due to factors like atrophy or hypertrophy. Therefore, it is imperative to recognize that a one-size-fits-all anatomical pattern for the LPM does not exist. Instead, a personalized therapeutic approach should be based on a case-by-case determination of the LPM’s specific anatomical configuration. This nuanced understanding challenges the simplistic view of the LPM and underscores the need for individualized clinical considerations. Full article

Introduction/Objectives: The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL remain limited. To evaluate patients’ long-term nasal- and tumor-related QOL after endoscopic endonasal resection of pituitary tumors and to detect predictors for poor postoperative QOL. Study Design: This study was a prospective cohort study. Methods: All patients with pituitary adenomas who underwent trans-sphenoidal surgery at Tel Aviv Sourasky Medical Center between 2014 and 2021 were recruited. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery and 1, 2, and 3–5 years after surgery. Clinical data were collected and analyzed. Results: The study included 43 patients (18 women). No significant decrease was observed in tumor-related quality of life (QOL) scores, measured by ASBS-Q and SNOT-22, throughout the 5-year follow-up period. SNOT-22 score differences from the preoperative baseline at years 1, 3, and 5 were 0.81 [−4.84–6.58], 3.35 [−4.32–11.02], and 3.73 [−2.22–9.68], respectively, with no statistically significant changes. ASBS-Q scores similarly showed no significant changes over time. Subgroup analyses revealed that tumor characteristics (secreting vs. non-secreting, size), surgical factors (intraoperative cerebrospinal fluid leak, gross tumor resection, use of nasoseptal flap), and endocrine remission did not significantly impact QOL (p > 0.05 for all variables). Conclusions: Our study demonstrated that patients who underwent endoscopic pituitary lesion resection maintained high nasal- and tumor-related quality of life over a 5-year follow-up period. However, given the limitations of our study, further multi-center studies with larger patient populations are warranted to validate these results. Full article