scholarly journals A Case of 40-Year-Old Male with Onodi Cell Mucocele

2020 ◽  
Vol 63 (8) ◽  
pp. 381-385
Author(s):  
Sung-Dong Cho ◽  
Seung Heon Kang ◽  
Yuju Seo ◽  
Hyun Jik Kim
Keyword(s):  
Visual Disturbance ◽  
Subjective Symptom ◽  
Ethmoid Sinus ◽  
Sinus Surgery ◽  
Initial Symptom ◽  
Orbital Apex ◽  
Lateral Direction ◽  
Onodi Cell ◽  
Field Disturbance ◽  
Sinus Ostium

Sphenoethmoidal (Onodi) cells originate from the ethmoid sinus and are located at the posterior and lateral direction. The obstruction of the sinus ostium leads to the accumulation of mucous fluid and eventually leads to the formation of a mucocele. Onodi cell mucoceles can cause visual loss or disturbance due to the adjacency to the orbital apex. Here we report a case of Onodi cell mucocele with a visual field disturbance, where the patient underwent an endoscopic sinus surgery 12 days after the initial symptom. After 21 days of onset, the subjective symptom started to subside. For Onodi cell mucocele patients with visual disturbance, we recommend rapid diagnosis with computed tomography and early marsupialization of the mucocele.

scholarly journals Granulomatosis with Polyangiitis Presenting with Bilateral Orbital Apex Syndrome

2021 ◽  
pp. 32-40
Author(s):  
Yusuke Murai ◽  
Takuji Kurimoto ◽  
Sotaro Mori ◽  
Kaori Ueda ◽  
Mari Sakamoto ◽  
...  
Keyword(s):  
Visual Field ◽  
Eye Movement ◽  
Endoscopic Sinus Surgery ◽  
Granulomatosis With Polyangiitis ◽  
Field Tests ◽  
Sinus Surgery ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Initial Examination ◽  
Steroid Pulse

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient’s VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.

Multiple spinal neurinomas presenting visual disturbance as the initial symptom: Case report

1992 ◽  
Vol 38 (4) ◽  
pp. 309-314 ◽  
Author(s):  
Susumu Oikawa ◽  
Kazuhiko Kyoshima ◽  
Toshiki Takemae ◽  
Shigeaki Kobayashi
Keyword(s):  
Case Report ◽  
Visual Disturbance ◽  
Initial Symptom

Hemangiopericytoma of the Sphenoid Sinus

1981 ◽  
Vol 89 (5) ◽  
pp. 713-716 ◽  
Author(s):  
Charles P. Kimmelman
Keyword(s):  
Radiation Therapy ◽  
Sphenoid Sinus ◽  
Vascular Tumor ◽  
External Beam Radiation ◽  
Orbital Apex ◽  
Tumor Nodule ◽  
Beam Radiation ◽  
The Right ◽  
Sinus Ostium ◽  
Ethmoid Labyrinth

A 51-year-old woman complained of intermittent nasal obstruction and rhinorrhea. Sinus roentgenograms and polytomograms revealed a small mucocele of the right sphenoid sinus. There was no encroachment of the orbital apex or intracranial contents. The mucocele was marsupialized via an external ethmoidectomy, and the scant tissue present inside the sinus was examined histologically. The pathologic diagnosis was hemangiopericytoma. The small tumor had apparently originated at the sinus ostium, thus creating the mucocele. Several months postoperatively, a small, vascular tumor nodule was noted in the incision. No recurrence was evident intranasally. A course of 5,040 rads of external beam radiation therapy was given to the right ethmoid labyrinth and right sphenoid. Since completing her radiation therapy, there has been no recurrence. This case is of interest because the tumor occurred as a mucocele of the sphenoid sinus.

scholarly journals A Case of Brain Herniation and Cerebrospinal Fluid Leakage during Endoscopic Marsupialization of Ethmoid Sinus Mucocele

2020 ◽  
Vol 63 (9) ◽  
pp. 427-431
Author(s):  
Song Jae Lee ◽  
Sang Gyu Park ◽  
Hae Won Choi ◽  
Kyung Rae Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Intervention ◽  
Brain Parenchyma ◽  
Ethmoid Sinus ◽  
Sinus Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Brain Herniation ◽  
Fluid Leakage ◽  
Adjacent Structures ◽  
Ethmoid Sinuses

Paranasal sinus mucocele is a slowly growing benign cystic lesion. It usually involves the frontal and ethmoid sinuses and can extend to adjacent structures, especially to the orbit, skull base and brain parenchyma. Prompt surgical intervention is needed when symptoms occur. Complete resection of mucocele is approached via endoscopic sinus surgery, while marsupialization is also widely considered. Recently, we encountered a case of spontaneous brain herniation and cerebrospinal fluid leakage during endoscopic marsupialization of ethmoid sinus mucocele. Herein, we report the case with a review of the literature.

scholarly journals The Prevalence of an Onodi Cell in Adult Thai Cadavers

2003 ◽  
Vol 82 (3) ◽  
pp. 200-204 ◽  
Author(s):  
Sanguansak Thanaviratananich ◽  
Kowit Chaisiwamongkol ◽  
Suthee Kraitrakul ◽  
Watcharachai Tangsawad
Keyword(s):  
Optic Nerve ◽  
High Risk ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Minimum Amount ◽  
Bone Thickness ◽  
Optic Nerve Injury ◽  
Nasal Endoscope ◽  
Anatomic Dissection ◽  
Onodi Cell

Endoscopic sinus surgery in patients who have an Onodi cell (sphenoethmoid cell) carries a high risk for optic nerve injury. We meticulously dissected 65 embalmed cadaver adult half-heads and attempted to identify an optic canal bulge in each with a nasal endoscope. Our aims were to determine the prevalence of an Onodi cell in adult Thai cadavers, to ascertain the prevalence of an overriding ethmoid cell, and to measure the length of an overriding ethmoid cell's superior and posterior extensions in relation to the anterior sphenoid wall. Moreover, we attempted to determine the minimum amount of bone thickness between an Onodi cell and the optic nerve. We found that an Onodi cell was present in 39 of the 65 specimens (60.0%). We also found that an overriding ethmoid cell was present in 14 specimens, which accounted for 21.5% of the total number of specimens and 36.8% of 38 Onodi cell-positive specimens (the presence or absence of an overriding ethmoid cell was not recorded in one of the 39 Onodi cell-positive specimens). The distance of the overriding ethmoid cell's superior and posterior extensions from the anterior sphenoid wall ranged from 3 to 13 mm (median: 7) and from 4 to 16 mm (median: 9.5), respectively. Measurements of the minimum amount of bone thicknesses between each Onodi cell and optic nerve ranged from 0.03 to 0.54 mm (median: 0.08). Our study demonstrated that the prevalence of an Onodi cell in adult Thai cadavers was as great as the prevalence reported in the only other gross anatomic dissection study performed in Asia and much higher than rates generally reported in Western countries.

scholarly journals A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ethan I. Huang ◽  
Chia-Ling Kuo ◽  
Li-Wen Lee
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Optic Nerve ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Sinus Surgery ◽  
Acute Visual Loss ◽  
Computed Tomography Images ◽  
Onodi Cell

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

scholarly journals Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

2015 ◽  
Vol 122 (6) ◽  
pp. 1380-1389 ◽  
Author(s):  
Silky Chotai ◽  
Yi Liu ◽  
Jun Pan ◽  
Songtao Qi
Keyword(s):  
Squamous Metaplasia ◽  
Visual Disturbance ◽  
Extent Of Resection ◽  
Initial Symptom ◽  
Cyst Volume ◽  
Suprasellar Cyst ◽  
Enhanced Mri ◽  
The Mean ◽  
Rathke's Cleft ◽  
Primary Focus

OBJECT Rathke's cleft cysts (RCCs) are benign lesions with a location that is entirely intrasellar, intrasellar with suprasellar extension (intrasuprasellar), or purely suprasellar. The recurrence of RCC is relatively uncommon. The present study was conducted to report clinical characteristics, histological features, and outcomes based on location of the cyst with a primary focus on analyzing the predictors of squamous metaplasia and recurrence in these 3 types of RCCs. METHODS A retrospective review of the medical records of patients with symptomatic RCCs who had undergone resection at the authors' institution was conducted. Data points, including clinical presentation, preoperative endocrine status, operative details, imaging findings, pathology, and clinical outcomes, were reviewed. A multivariable regression model was used to identify predictors of recurrence. RESULTS The mean age of the 87 eligible patients, 64 females and 23 males, was 41 ± 14 years (range 10–73 years). Sixteen patients (18%) had an entirely intrasellar RCC, 21 (24%) had a purely suprasellar cyst, and 50 (58%) had an intrasuprasellar RCC. The mean cyst volume was 2.4 ± 0.9 cm3 (range 0.36–4.9 cm3). Headache was the most frequent initial symptom (76%) followed by visual disturbance (45%). The transsphenoidal approach was performed for all intrasellar RCCs (16 cysts) and 33 of 50 intrasuprasellar RCCs. The transcranial route was used for all suprasellar cysts (21 cysts) and 17 of 50 intrasuprasellar RCCs. Squamous metaplasia was present in 27 (31%) of 87 RCCs. The occurrence of squamous metaplasia was associated with cyst location (p = 0.027), T1 signal intensity (p = 0.004) and ring enhancement on Gd-enhanced MRI (p = 0.017), and cyst volume (p = 0.045). A suprasellar location (p = 0.048, OR 3.89, 95% CI 1.010–15.020), ring enhancement on Gd-enhanced MRI (p = 0.028, OR 3.922, 95% CI 1.158–13.288), hypointensity on T1-weighted MRI (p = 0.002, OR 6.86, 95% CI 1.972–23.909), and cyst volume (p = 0.01, OR 0.367, 95% CI 0.170–0.789) were independent predictors of squamous metaplasia. The mean time to reaccumulation (11 [12.6%] of 87 cases) and recurrence (7 [8%] of 87 cases) was 14 ± 6 months. Recurrence-free survival was 84.5% at a mean of 98.2 ± 4.6 months after treatment. A suprasellar cyst location (p = 0.007, OR 7.7, 95% CI 1.75–34.54), the occurrence of squamous metaplasia (p = 0.007, OR 19.3, 95% CI 2.25–165.18), and isointensity on T2-weighted MRI (p = 0.041, OR 10.29, 95% CI 1.094–96.872) were the independent predictors of RCC recurrence. CONCLUSIONS A suprasellar cyst location, the occurrence of squamous metaplasia, and isointensity on T2-weighted MRI were independent predictors of RCC recurrence. The extent of resection and type of surgical approach used were not associated with recurrence. A tailored extent of resection based on cyst location and predictive factors is recommended.

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