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Sphenoid Sinus Aspergiilosis Presenting Abducens Nerve Palsy and Visual Field Impairment;Acase report Akira MATSUNO 1,3 , Shinichi YOSHIDA 1 , Norihiko BASUGI 1 , Masanobu EGUCHI 2 1Department of Neurosurgery, Kanto Rosai Hospital 2Department of Pathology, Kanto Rosai Hospital Keyword: Aspergillosis , Sphenoid sinus , Antifungal therapy , Intracral involvement pp.799-804
Published Date 1992/7/10
DOI https://doi.org/10.11477/mf.1436900496
  • Abstract
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A case of sphenoid sinus aspergillosis presenting abducens nerve palsy and visual field impairment is re-ported. A 73-year-old woman visited our hospital with the complaint of head heaviness on the 27th of March, 1989. Although results of neurological examinations were normal, craniogram revealed the destruction of the clivus, and CT scan and MRI showed a mass le-sion, which was thought to he a mucocele in the sphe-noid sinus. On the 1st of September, she developed right abducens nerve palsy and visual field impairment. MRI performed on the same day showed an enlarge-ment of the mass lesion in the spheniod sinus.In order to decompress the involved cranial nerves, her sphenoid sinus was explored on the 22nd of September. The sphenoid sinus was filled with purulent fluid and yellowish mass. Histopathological examina-tion revealed colonies of aspergillus fumigatus. Fulco-nazole, a new antifungal drug, was given for 34 days postoperatively. The right abducens nerve palsy and the visual field impairment gradually improved along with a reduction of the mass lesion in her sphenoid sinus.

Sphenoid sinus aspergillosis is a rare disease. Its di-agnosis is difficult. However, MRI can show a specificlow signal intensity in T2-weighted image. Also in our case, MRI on the first admission showed a definite low signal intensity in some parts of the lesion, which exhi-bited a high intensity later on during the second admis-sion, probably due to a qualitative change.

To our knowledge, only 33 such cases have been pre-viously reported. Intracranial involvement occasionally occurs in this disease. In its early stage, cranial nerve palsies are caused by nerve compression or invasion by this disease. This is because these nerves run along the cavernous sinus. Meningitis or vasculitis of the internal carotid artery also occurs in the advanced stage of this disease. Six patients were reported to have died of in-tracranial involvement. Postoperatively, such invasive type of sphenoid sinus aspergillosis should be treated aggressively with new antifungal drugs, such as fluco-nazole, or itraconazole.


Copyright © 1992, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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