Headache Secondary to Isolated Sphenoid Sinus Fungus Ball: Retrospective Analysis of 6 Cases First Diagnosed in the Neurology Department

Abstract

Fungal sphenoid sinusitis is easily misdiagnosed in clinic, particularly for patients with normal immunological status. Due to the anatomic characteristics of sphenoid sinus, patients presented with various nonspecific symptoms and complications. Headache is the most common presentation, but location of headache is not fixed. We intended to analyze 6 cases of headache secondary to the isolated sphenoid sinus fungus ball (SSFB) which were first diagnosed in the Neurology Department. There was significant female predominance with mean ages of 55 years. They had repeatedly headache history from months to years. The headache was unilateral and usually on the side of lesions. Medication of pain relievers worked well in the beginning of SSFB, but not in the late stage of disease. Notably, all patients did not present positive nervous systemic signs. A preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) demonstrated the inflammation in sphenoid sinus. Some cases showed calcification in soft tissue or bone lesions of sinus wall. All of 6 patients undertook transnasal endoscopic sphenoidotomy without antifungal therapy after operation. Characteristic fungus ball (FB) was detected after histopathological examination. No headache recurrence was found after average 15.5 months follow-up. Our results suggested that transnasal endoscopic sphenoidotomy is the treatment of choice to remove the FB in sphenoid sinus with a low rate of morbidity and recurrence.

Isolated sphenoid sinus disease; a retrospective review of underlying pathologies and their clinicopathological implications

“…3,6 Interestingly, the mean age of the affected individuals in several of the previous reports is around 54-55 years, which is identical to the mean age of patients included in the current study. 7,8 Even for gender predilection, our cohort was in line with the literature that reports female preponderance for ISSD than males. 3,8,9 So far as the clinical manifestations of the isolated sphenoid sinus is concerned, headache remains to be the most common clinical symptom (50 to 82%), followed by ocular manifestations.…”

“…7,8 Even for gender predilection, our cohort was in line with the literature that reports female preponderance for ISSD than males. 3,8,9 So far as the clinical manifestations of the isolated sphenoid sinus is concerned, headache remains to be the most common clinical symptom (50 to 82%), followed by ocular manifestations. 4,[7][8][9][10][11][12][13] Headache related to ISSD is localized to the vertex, mainly on the affected side, but could be diffuse and bilateral if the condition affects sinuses on both sides.…”

Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature

“…Mean time to recurrence was 15 months (8–26 months). Recurrence rate of inflammatory sphenoid sinus disease varies greatly in the literature, ranging from 0 to 20.8% [ 1 , 8 , 14 , 15 , 22 , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]. Many authors have reported a high percentage of recurrences and reossification of the surgically opened sphenoid ostium.…”

“…This study is particularly relevant because it demonstrates the refractory character of inflammatory pathologies of the sphenoid sinus, with some patient requiring surgical intervention on 3 different occasions for recurrent sphenoid disease. However, many groups have presented series of patients with surgically treated isolated sphenoidal sinusitis for which recurrence rates were much smaller or even null [ 1 , [26] , [27] , [28] , [29] , [30] , [31] , [32] ]. One of the reasons that may explain the difference between these low reported recurrence rates is the duration of follow-up.…”

“…Furthermore, some series carried postoperative follow-up with telephonic encounters. Since recurrences may be asymptomatic, cases may be missed and therefore recurrence rate from these series are not interpretable [ 26 , 27 ].…”