侵犯顱底部之巨形蝶篩竇黏液囊腫──病例報告

Large Sphenoethmoid Mucocele with Skull Base Extension-A Case Report

蝶篩竇黏液囊腫為一罕見、良性、生長緩慢、具侵犯性的疾病，造成的原因可能與鼻竇竇口的阻塞或黏膜慢性發炎有關。由於蝶竇結構周圍有許多重要的神經與血管，臨床表現視其侵犯的部位而定，早期症狀多不具特異性，以枕骨區深部的頭痛或眼球後疼痛來表現，其他症狀有複視、視力障礙、視野缺損等。目前治療是以鼻竇內視鏡手術為主流。本院於2007年8月，經歷一名48歲男性，主訴為鼻塞、枕骨區深部頭痛及左眼部脹痛持續4年。腦部電腦斷層檢查發現左側篩竇及蝶竇有一巨大的黏液囊腫，核磁共振檢查顯示無硬腦膜或眼眶的侵犯，接受鼻內視鏡蝶竇切開造口術，術後病人症狀改善，至2008年7月於門診追蹤，並無復發現象。

Sphenoethmoid mucoceles are rare, benign, and expansile cyst-like lesions of the paranasal sinuses. They form secondary to chronic inflammation or sinus ostia obstruction. Sphenoethmoid mucocele symptoms and clinical signs are directly related to the anatomical location of the associated sinus and contiguous structures. Occipital and retro-orbital headaches are the most common symptoms. Ophthalmologic symptoms and clinical findings include vision loss, visual field deficits, and diplopia. Endoscopic sinus surgery is widely accepted as a safe and effective approach in mucocele management. We evaluated a 48-year-old man in August 2007 with a 4-year duration of nasal obstruction and headaches. His past clinical history included a Caldwell-Luc’ s operation 20 years prior to presentation. Computed tomography (CT) was performed on the brain and revealed a large mucocele in the left ethmoid and sphenoid sinuses. Magnetic resonance imaging (MRI) confirmed the presence of a homogenous mass in the sphenoethmoidal sinus without dural invasion or orbital medial wall erosion. The patient underwent an endoscopic sphenoidotomy with marsupialization. Clinical symptoms resolved post-operatively.