Endoscopic Endonasal Management of Invasive Skull Base Mucocele: Report of Two Cases

Abstract

Two cases of massive erosive skull base sphenoid mucocele are reported. Even if intra-sphenoid mucoceles are an ENT pathology, when extensive they become of neurosurgical interest. An endoscopic minimally invasive procedure was performed in both cases with an excellent outcome. Patient 1 presented with several years of retro-orbital bilateral pain and several months of purulent pharyngeal leak. CT scan and MRI imaging showed an extensive erosive intra-sphenoid mass, with peripheral contrast enhancement. Patient 2 was referred because of several months of frontal headache and decreased left visual acuity. A wide intra-sphenoid mass was evident at CT scan and MRI. This mass included an anterior compartment, hyperintense on both T₁- and T₂-weighted images, and a posterior part, hypointense on T₁- and hyperintense on T₂-weighted images. A pure endoscopic endonasal one nostril pure procedure was performed in both cases. Endoscopic technique has been shown to be an easy and minimally invasive procedure. It should be the treatment of choice in case of invasive skull base mucocele in order to avoid blind damage of vasculo-nervous structures which are not protected by the bone, extensively eroded by the lesion.

Key words

Endoscopic technique - invasive sphenoid mucocele - skull base

References

• 1 Grossman R I, Yousem D M. Sinonasal disease. In: Neuroradiology. The requisites. St Louis: Mosby, Inc. 1994 359-376 368
• 2 Sethi D S. Isolated sphenoid lesions: diagnosis and management.  Otolaryngol Head Neck Surg. 1999;  120 730-736
• 3 Som P M, Lawson W, Lidov M V. Simulated aggressive skull base erosion in response to benign sinonasal disease.  Radiology. 1991;  180 755-759
• 4 Har-EI G. Endoscopic management of 108 sinus mucocele.  Laryngoscope. 2001;  111 2131-2134