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INTRODUCTION AND OBJECTIVES: Anatomical variations of the lateral recess of the sphenoid sinus and its relations with the adjacent neurovascular structures should be preoperatively evaluated to plan an adequate surgical approach and avoid iatrogenic injuries. This study aims to analyze the patterns of pneumatization of the lateral recess of the sphenoid sinus and their association with the presence of protrusion and dehiscence of the optic canal, carotid canal, vidian canal, and maxillary nerve. MATERIALS AND METHODS: A retrospective evaluation of 320 sphenoid sinuses by computed tomography was performed. Studied variables included type of lateral recess, and protrusion, and dehiscence of the optic and carotid canal, and vidian and maxillary nerve. RESULTS: The mean age was 45.67±17.43. A total of 55.6% (n=178) of the evaluated sphenoid sinuses corresponded to male subjects. Protrusion of the carotid canal, maxillary nerve, and vidian canal was associated with a type 3 lateral recess pneumatization, while dehiscence of these structures was most commonly observed in a type 2 lateral recess (p=<0.001). CONCLUSIONS: Protrusion or dehiscence of neurovascular structures surrounding the sphenoid sinus has been associated with the extent of pneumatization of the lateral recess, increasing the risk of intraoperative injury. Preoperative identification of anatomical variations is mandatory to select the best approach for skull base lesions and avoid iatrogenic injuries.

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Resumen La neumatización detenida de los senos paranasales es una condición benigna poco conocida, que consiste en una variación de la neumatización normal, permaneciendo médula ósea grasa dentro de la cavidad, siendo más frecuente en el seno esfenoidal. Es generalmente asintomática y su diagnóstico suele ser incidental en el contexto de la realización de imágenes por otras causas, existiendo criterios imagenológicos definidos para esta condición. Su manejo es expectante y es esencial su distinción de otros diagnósticos diferenciales, con objeto de evitar procedimientos y tratamientos invasivos que solo aporten morbilidad. Presentamos dos casos de pacientes, de 15 y 16 años que, en estudio imagenológico por otra causa, se observan lesiones esfenoidales heterogéneas con focos de baja señal sugerentes de calcificaciones, con características compatibles con neumatización detenida del seno esfenoidal.

Abstract Arrested pneumatization of the paranasal sinuses is an under-recognized benign condition, which consists of a variation of the normal pneumatization, with fatty bone marrow remaining within the cavity, more frequent in the sphenoid sinus. It is generally asymptomatic, and its diagnosis is usually incidental in the context of imaging for other causes, with defined imaging criteria for this condition. Its management is expectant and its distinction from other differential diagnoses is essential, in order to avoid invasive procedures and treatments that only contribute morbidity. We present two cases of 15- and 16-year-old patients who, on imaging for another reason, show heterogeneous sphenoid lesions with low-signal foci suggestive of calcifications, with characteristics compatible with arrested pneumatization of the sphenoid sinus.

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INTRODUCCIÓN: La enfermedad aislada del seno esfenoidal es rara y representa el 1-2% de todas las patologías inflamatorias sinusales y < 0,05% de las lesiones malignas sinusales. Es difícil establecer el diagnóstico debido a la presentación clínica inespecífica. La cefalea frontal y/o retroocular es la principal manifestación. El retraso en el diagnóstico y tratamiento puede resultar en serias complicaciones debido a sus relaciones anatómicas. OBJETIVOS: Presentar nuestra experiencia en lesiones esfenoidales aisladas, analizando sintomatología, etiología, diagnóstico y tratamiento de las mismas...

INTRODUCTION: Isolated sphenoid sinus disease is rare and accounts for1-2% of all inflammatory sinus pathologies and <0.05% of malignant sinus lesions. It is difficult to establish the diagnosis due to its nonspecific clinical presentation. Frontal and/or retro-ocular headache is the main symptom. Delay in diagnosis and treatment can result in major complications due to their anatomical relationships. OBJECTIVE: Present our experience in isolated sphenoid injuries, through the analysis of symptomatology, etiology, diagnosis and treatment of them...

INTRODUÇÃO: a doença isolada do seio esfenoidal é rara e representa entre 1% e 2% de todas as patologias inflamatórias sinusais e menos de 0,05% das lesões malignas sinusais. É difícil estabelecer o diagnóstico devido a apresentação clínica inespecífica. A cefaleia frontal e/ou retro-ocular é a principal manifestação. O atraso no diagnóstico e no tratamento pode causar complicações sérias devido à suas relações anatômicas. OBJETIVOS: Apresentar nossa experiência em lesões esfenoidais isoladas, analisando a sintomatologia, etiologia, diagnostico e o tratamento...

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RESUMEN Las fístulas de líquido cefalorraquídeo (LCR) corresponden a una comunicación anómala entre el espacio subaracnoideo y la cavidad nasal. El origen de las fístulas laterales del seno esfenoidal se encuentra en un defecto congénito de la base del cráneo, con una incompleta o prematura fusión de los componentes óseos implicados en el complejo proceso de osificación del esfenoides. Ello origina un canal sin cobertura ósea, solo cubierto por tejido conectivo, denominado canal craneofaríngeo lateral o de Sternberg. Este es un punto débil donde pueden aparecer encefaloceles y/o fístulas, su ubicación lateral en el seno constituyen una zona de difícil abordaje quirúrgico. La reparación quirúrgica de fístulas de LCR ha progresado drásticamente con el desarrollo de ópticas endoscópicas y la mejora en el conocimiento de la anatomía de la base de cráneo. Los endoscopios permiten una visualización directa, localización del defecto y por ende una reparación precisa que traduce menos recidivas y menor morbilidad asociada a accesos transcraneales realizados previamente. El propósito de este artículo es presentar el caso de paciente con fístula del receso lateral del seno esfenoidal, su reparación endoscópica y discusión del origen de la persistencia del canal de Sternberg como causa del defecto.

ABSTRACT Fístulas liquid cerebrospinal (CSF) correspond to an abnormal communication between the subarachnoid space and the nasal cavity. The origin of lateral fístulas of the sphenoid sinus is a congenital defect of the skull base, with an incomplete or premature fusion of bone components involved in the complex process of ossification of sphenoid. This originates a channel without bone coverage, only covered by connective tissue, called channel craneofaringeo or Sternberg channel. This is a weak point where may appear encephaloceles and/or fístula, the lateral location in sinus is a difficult surgical approach. Surgical repair of fístulas of CSF has progressed dramatically with the development of endoscopic optics and the improvement in the knowledge of the anatomy of the skull base. Endoscopes enable a direct visualization, location of the defect and thus accurate reparation and less morbidity associated with transcraneales accesses made previously. The purpose of this article is to present the case of patient with fístula of the lateral recess of the sphenoid sinus, endoscopic repair and discussion of the origin of the persistence of the channel of Sternberg as a cause of the defect.

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Objective To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment - ICD1 and horizontal cavernous segment - ICD2) and compared to twenty paired controls. Results There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.

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ABSTRACT Objective To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment – ICD1 and horizontal cavernous segment – ICD2) and compared to twenty paired controls. Results There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.

RESUMO Objetivo Avaliar a distância intercarotídea (DIC) de pacientes com macroadenoma de hipófise e comparar com controles saudáveis. Método Foram analisados retrospectivamente imagens de ressonância magnética com contraste de vinte pacientes consecutivos com diagnóstico de macroadenoma hipofisário não-funcionante, medidas as DIC em dois níveis diferentes (segmento petroso – DIC1 e segmento cavernoso horizontal – DIC2) e comparados com vinte controles pareados. Resultados Não houve diferença estatisticamente significativa da DIC1 média entre os grupos e subgrupos. Para a DIC2 houve diferença estatisticamente significativa entre os casos e controles. No entanto, não houve diferença significativa entre os doentes com adenomas menores e os controles. Entretanto, os pacientes com adenomas gigantes tiveram estatisticamente significativamente DIC2 que os controlos. Conclusão A DIC no segmento horizontal da carótida cavernoso, tende a ser mais larga em doentes com adenomas hipofisários gigantes do que em indivíduos saudáveis ou de pacientes com adenomas menores.

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OBJECTIVE: To present the first case in the English literature of a sphenoid xanthoma. METHODS: Case Report DISCUSSION: A 36 year-old Hispanic female with past medical history of Hashimoto's hypothyroidism and family history of hyperlipidemia that presented with a 1-year history of sporadic left sided epistaxis. A paranasal sinus Computed Tomography (CT) was performed revealing a soft tissue lesion infiltrating the left sphenoid sinus. Patient underwent endoscopic sinus sphenoidotomy with intraoperative findings of a yellow-tan, friable soft tissue mass filling the left sphenoid sinus. Biopsies were taken which exhibited histologically findings consistent with a xanthoma. CONCLUSION: In a patient with hyperlipidemia isolated lesions on paransasal sinuses can be related to xanthoma formation.

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We present a case of sphenoid sinus fungus ball caused by Aspergillus fumigatus associated with actinomycosis. This case represents the first known reported infection caused by this rare association.

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CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present. .

CONTEXTO: Macroadenomas hipofisários são tumores intracraniais raros. Em alguns casos, podem apresentar comportamento agressivo e invadir o seio esfenoidal e a cavidade nasal, causando sintomas não usuais. Neste relato de caso, descrevemos um caso atípico de adenoma hipofisário manifestando-se como uma massa nasal. RELATO DE CASO: A paciente de 44 anos, do sexo feminino, apresentava amenorreia e galactorreia por 10 meses associando-se a obstrução nasal, macroglossia e acromegalia. Os níveis do hormônio de crescimento e de prolactina apresentaram-se aumentados. Ressonância magnética mostrou uma grande massa originada da superfície inferior da glândula hipofisária associada com erosão da sela túrcica e extensão do tumor através do seio esfenoidal e cavidade nasal. Análise histopatológica demonstrou adenoma hipofisário cromófobo com células epiteliais arrendondadas densamente agrupadas com algumas atipias e escassas figuras de mitose. Não houve evidências de metástase. CONCLUSÃO: O macroadenoma invasivo para a cavidade nasal é uma condição rara e há poucos relatos similares descritos na literatura. Este trabalho contribui para mostrar que, na presença de sintomas atípicos como a obstrução nasal, a extensão para o seio esfenoidal e para a nasofaringe deve ser considerada e investigada para um diagnóstico precoce. .

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CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

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