BACKGROUND: Fungal sphenoiditis is a rare case in clinical practice. Usually affecting just one sinus, Aspergillus is the most common cause of fungal sinusitis. Atypical headache with unresponsive to analgetics is one of symptom from Isolated Sphenoid sinusitis.
METHODS: This case report presents a 37 year old female with isolated sphenoiditis fungal. The patient came with atypical headache as the major symptom.
UNASSIGNED: Based on the morphology of the sphenoid sinus and its surrounding structures, diagnosis is often challenging.
CONCLUSIONS: After some medicine, the chief complaint did not disappear. A functional endoscopic sinus surgery was performed to remove the fungal ball, and the patient get good result.

This article presents an analytical review of scientific publications on the topic of surgical treatment of isolated lesions of the sphenoid sinus. The publications, research data presented in the RSCI database, PubMed in the period 1985-2021 are analyzed. The selection of the material was carried out according to the keywords: sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis, endoscopic sphenotomy, relapses of sphenoiditis, sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis.
Представлен систематический обзор научных публикаций по теме хирургического лечения изолированных поражений клиновидной пазухи. Проанализированы публикации, представленные в базах данных РИНЦ, PubMed в период 1985—2021 гг. Выбор материала осуществляли по ключевым словам: клиновидная пазуха, изолированный сфеноидит, фенотипы сфеноидита, эндоскопическая сфенотомия, рецидивы сфеноидита.

The rarity of isolated sphenoid sinus disease (ISSD) and the specificity of pediatric populations meant that a separate analysis was required in this study. This study aimed to present and discuss the results of an analysis of clinical manifestations, radiological findings and surgical methods based on a large series of exclusively pediatric patients. The study group covered 28 surgically treated children (aged 5.5-17.5 years). The medical data were retrospectively analyzed and meticulously discussed with regards to presenting signs and symptoms, radiographic findings, surgical approaches, complications, post-op care, histopathological results and follow-ups. The dominant symptom was a persistent headache (78%). Four children presented visual symptoms, diplopia in two cases, visual acuity disturbances in one case and both of these symptoms in one patient. Sixteen children presented chronic isolated rhinosinusitis without nasal polyps, six suffered from mucocele and one presented chronic sphenoiditis with sphenochoanal polyp. Four patients turned out to exhibit neoplastic lesions and developmental bony abnormality was diagnosed in one case. No fungal etiology was revealed. The transnasal approach was used in 86% of patients. A transseptal approach with concurrent septoplasty was used in four patients. The patient with visual acuity disturbances completely recovered after the surgery. All children with visual symptoms reported improvement in the vision immediately after surgery. No postoperative complications were observed. Fungal etiology was extremely rare in the pediatric population with ISSD. The surgical treatment should be a minimally invasive procedure regarding a limited range of the pathology in ISSD. Emergency surgery should be performed if ISSD produces any visual loss.

The relevance of the issues of diagnosis and treatment of isolated sphenoiditis (IS) is increasing, due to the widespread introduction into clinical practice of radiation diagnostic methods that allow the diagnosis, including latent forms of IS. Among the chronic forms of IS, polypous-cystic and fungal lesions of the sphenoid sinus (SS) predominate.
OBJECTIVE: To study the age, gender and radiological features of SS in patients with IS.
METHODS: A retrospective observational single-center non-randomized study was conducted - an analysis of the case histories of 56 patients aged 18 to 68 years who were on inpatient treatment at the Semashko Nizhny Novgorod Regional Clinical Hospital (Department of Ear, Throat and Nose Diseases of the Privolzhsky Research Medical University) in the period 2018-2020, by age, gender composition, clinical and radiological manifestations in various forms of IS.
RESULTS: The duration of the disease was 59±19 days. Latent forms were detected in 40% of patients. Statistically, the polypous-cystic form of IS was diagnosed more often than the fungal one (z=4.2; p=0.001). The median age of patients with polypous-cystic and fungal IS was 46.5 [35.0; 59.0] years. Evaluation of computed tomograms on the Lund-Mackay scale showed higher values in patients with polypous-cystic IS than in patients with fungal SS lesion (p=0.07). Obstruction of the anastomosis was detected in 38 out of 50 (69.5%) patients with polypous-cystic IS and in 13 out of 50 (92.9%) patients with fungal IS.
CONCLUSIONS: Against the background of a significant prevalence of rhinosinusitis, the absolute values of isolated sphenoiditis, even with a relative value of 5% of the total, are very significant. Determining the phenotype of isolated sphenoiditis and their features is very important for building a consistent treatment strategy. Age, gender, clinical and radiological manifestations should form the basis of phenotyping and further construction of a therapeutic and diagnostic algorithm.
Актуальность вопросов диагностики и лечения изолированного сфеноидита (ИС) все более возрастает, что обусловлено широким внедрением в клиническую практику лучевых методов диагностики, которые позволяют диагностировать в том числе латентные формы ИС. Среди хронических форм ИС преобладают полипозно-кистозные и грибковые поражения клиновидной пазухи (КП).
UNASSIGNED: Изучить возрастные, гендерные и рентгенологические особенности КП у пациентов с ИС.
UNASSIGNED: Проведено ретроспективное обсервационное одноцентровое нерандомизированное исследование — анализ историй болезни 56 пациентов в возрасте от 18 до 68 лет, находившихся на стационарном лечении в ГБУЗ НО «НОКБ им. Н.А. Семашко» (кафедра болезней уха, горла и носа ФГБОУ ВО «ПИМУ» Минздрава России) в период 2018—2020 гг., по возрастному, гендерному составу, клиническим и рентгенологическим проявлениям при различных формах ИС.
UNASSIGNED: Давность заболевания составила 59±19 дней. У 40% пациентов выявлены латентные формы. Статистически чаще диагностировали полипозно-кистозную форму ИС, чем грибковую (z=4,2; p=0,001). Медиана возраста пациентов с полипозно-кистозным и грибковым ИС составила 46,5 [35,0; 59,0] года. Оценка компьютерных томограмм по шкале Лунда—Маккея показала более высокие значения у пациентов с полипозно-кистозным ИС, чем у пациентов с грибковым поражением КП (p=0,07). Обструкция соустья выявлена у 38 из 50 (69,5%) больных с полипозно-кистозным ИС и у 13 из 50 (92,9%) больных с грибковым ИС.
UNASSIGNED: На фоне значительной распространенности риносинусита абсолютные значения изолированного сфеноидита, даже при относительной величине 5% от общего количества, весьма значительны. Определение фенотипа изолированного сфеноидита и их особенностей очень важно для построения последовательной лечебной стратегии. Возрастные, гендерные, клинико-рентгенологические проявления должны лежать в основе фенотипирования и дальнейшего построения лечебно-диагностического алгоритма.

OBJECTIVE: To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis.
METHODS: The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected.
RESULTS: Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41-84) vs. 57.43 (36-81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis.
CONCLUSIONS: This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.

BACKGROUND: Invasive sinonasal aspergillosis is a silently progressive disease that, left untreated, may invade the adjacent intracranial and intra-orbital compartments incurring serious morbidity.
OBJECTIVE: To evaluate our results of a collaborative surgical management plans for patients with invasive sinonasal aspergillosis with orbitocranial extension.
METHODS: Retrospective study.
METHODS: Between the years 2000 and 2012, 12 patients with Aspergillus sinusitis with orbitocranial extension were treated at our institution. Preoperative CT and MRI scans were done in all cases and cerebral angiography in two patients with subarachnoid hemorrhage (SAH). Surgical combined transcranial and endonasal approaches to the skull base were considered in all patients. Adjuvant antifungals were administered postoperatively with regular clinical and radiologic follow up.
RESULTS: All cases had a long history of headache and nasal obstruction (n = 12). Five presented with unilateral proptosis, one with meningitis, one with epilepsy, two with SAH, and one patient presented with trigeminal neuralgia. Craniotomy alone was chosen for the patients with isolated sphenoiditis (n = 2) while a combined cranial and endonasal approach was elected for the other patients (n = 10). Adjuvant antifungal therapy was used for 3-12 months. Patients were followed up clinically and radiologically for an average 36-month period (range = 12-50 months) with disease eradication achieved in eight patients (67%). Two died as consequence to SAH. Follow up also showed that three patients (25%) had sinunasal recurrence requiring evacuation through an endonasal approach.
CONCLUSIONS: Surgical intervention, with adjuvant antifungal therapy, aiming for safe total removal of the fungal burden, whenever feasible, has a major role in the management of invasive sinonasal aspergillosis with orbitocranial extension with minimal morbidity and good outcomes.

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