Endoscopic Management of Paranasal Sinus Mucoceles: Meta‐analysis of Visual Outcomes

Abstract

Objective Paranasal sinus mucoceles are benign cystic lesions originating from sinus mucosa that can impinge on adjacent orbital structures, causing ophthalmic sequelae such as decreased visual acuity. Definitive treatment requires surgery. We present the first meta-analysis quantifying the effect of preoperative visual function and time to surgery on postoperative visual acuity outcomes. Data Sources PubMed, Ovid, Embase, Web of Science, and the Cochrane Library. Methods Two independent authors systematically reviewed articles describing outcomes after endoscopic sinus surgery for paranasal sinus mucoceles presenting with visual loss. Available data from case reports and series were combined to analyze the associations among preoperative visual acuity, time to surgery, and postoperative outcomes. Results Eighty-five studies were included that provided data on 207 patients. The average presenting visual acuity was 1.57 logMAR (logarithm of the minimum angle of resolution), and the average postoperative visual acuity was 0.21 logMAR, with visual improvement in 71.5% of cases. Preoperative visual acuity ≥1.52 logMAR correlated with postoperative improvement >1 logMAR (R = 0.4887, P<.0001). A correlation was found between a time to surgery <6 days and postoperative improvement (R = 0.297, P <.0001). Receiver operator curve analysis of these thresholds demonstrated a moderately accurate prognostic ability (area under the curve: 75.1 for preoperative visual acuity and 73.1 for time to surgery). Conclusion Visual loss resulting from paranasal sinus mucoceles is potentially reversible in most cases, even those presenting with poor vision. When possible, surgery should be performed promptly after diagnosis, but emergency surgery does not appear to be necessary for vision restoration.

Paranasal sinus mucocele with visual disturbances whose causative legion was hardly identified on computed tomography imaging: A case report

“…Paranasal sinus mucoceles with visual disturbances are treatable diseases only if optic nerves were decompressed promptly [2]. Previous studies reported that the time to surgery and preoperative visual acuity could predict postoperative visual acuity improvement [3,4]. In the current case, we surmise that further delay of even short hours before surgery might be harmful to vision outcome since the patient's vision was severely and rapidly deteriorated.…”

Predictors of Visual Acuity and Usefulness of a Treatment Algorithm in Rhinogenous Optic Neuritis

“…In a meta-analysis of 85 reports (comprising a collective total of 207 patients) on visual disturbance involving paranasal sinus mucoceles, a time from onset to surgery of <6 days was associated with improved visual acuity outcomes, indicating the importance of early surgical intervention. 2 Moriyama et al 10 also noted that in patients exhibiting a gradual progression from mild to moderate visual disturbance, the recovery of visual acuity depends on the time from onset to surgery. In the current study, the time from onset to surgery for rhinogenous optic neuritis was identified as a significant predictor of postoperative visual acuity.…”

“…Finger counting, hand motion, light perception, and no light perception cannot be represented as (d) and were calculated as 1.9, 2.3, 2.7, and 3.0, respectively, in accordance with a previous study. 2 The values were calculated to the second decimal place. Recovery of visual acuity was defined as an improvement of !2 lines in logMAR.…”

Post-Radiation Sphenoidal Mucocele in a Patient Treated for Nasopharyngeal Cancer

“…Paranasal sinusmucoceles are benign pseudocystictumors, they have an expansive and destructive tendency and a slow evolution. 1 All locations are possible; they are frequently found in the frontal sinus, the anterior ethmoidal sinus, the maxillary sinus, while posterior ethmoidal sinus and sphenoid sinus are rarely affected (less than 1%). 3 Ostial obstruction have been advanced to explain their etiopathogenesis.…”

“…As a result, it exerts pressure on the surrounding structures. 1 Previous trauma and sinus surgery are the most common cause. Mucoceles following radiotherapy are rare.…”