蝶形骨洞から海綿静脈洞に広がる炎症性肉芽腫—3症例の報告

Inflammatory Granulomas Extending from the Sphenoid Sinus to the Cavernous Sinus:Report of three cases

I．はじめに

　一般に，一側性の眼球運動障害と同側の眼窩部痛を伴う症例は，painful ophthalmoplegiaと言われている^9）．その原因として，海綿静脈洞，眼窩，上眼窩裂，傍鞍部などに発生した腫瘍，動脈瘤，炎症，外傷などの病変が挙げられている^9）．その中で，benign steroid sensitivegranulomaによるものは，Tolosa-Hunt症候群と呼ばれる^5）．著者らは，蝶形骨洞より海綿静脈洞に伸展する炎症性肉芽腫の3症例を経験したが，MRI上も興味ある所見を示したので，Tolosa-Hunt症候群との関連について検討し報告する．

Abstract

We treated three cases of inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus. Case 1 was that of a 36-year-old male with diplo-pia and right ptosis. Case 2 was that of a 40-year-old male with frontal headache. Case 3 was that of a 70-year-old female with left impaired vision and frontal headache. In the first case, MRI demonstrated a mass lesion extending from the right half of the sphenoid sinus to the cavernous sinus and retropharyngeal space. In the second case the granuloma extended from the right cavernous sinus to the right retroorbital space. In the last case, MRI demonstrated diffuse Gd-DTPA en-hancement of the left cavernous sinus and the left half of the sphenoid sinus. In all cases an operation was performed using the sublabial rhinoseptal approach, and the tumor in the sphenoid sinus was removed. His-tological examination revealed an inflammatory granu-loma in all 3 cases. In the first case the clinical symp-toms improved following administration of glucocorti-coids. In the second case the mass in the cavernoussinus decreased in size postoperatively. In the last case, the clinical symptoms gradually improved with admi-nistration of antibiotics after surgery.

Granuloma of the cavernous sinus is difficult to dia-gnose, but when a similar pathological lesion coexists in the sphenoid sinus, a definitive diagnosis can be easi-ly made via the sublabial rhinoseptal approach.