Temporary Unilateral Amaurosis with Pneumosinus Dilatans of the Sphenoid Sinus

Bachor, Edgar; Weber, Rainer; Kahle, G.; Draf, Wolfgang

doi:10.1055/s-2008-1058970

Cited by 23 publications

(10 citation statements)

References 28 publications

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“…However, the exacerbation of symptoms in patients flying or climbing at high altitudes has lent weight to the valve-like theory. 14,15 Endoscopic examination of our patient showed the valve represented by an Agger nasi cell pneumatization near the ostium of the frontal sinus and associated with hyperplastic changes in the nasal mucosa, thus confirming the valve-like theory as one of the possible mechanisms responsible for this sinus disorder. In addition, spontaneous resolution of a mucocele may be another mechanism for PSD formation.…”

Section: Discussionsupporting

confidence: 59%

“…Indeed, amaurosis fugax related to altitudes above 2000 meters, which spontaneously disappeared at lower altitudes, has been described in two different cases. 14,15 The authors attributed the amaurosis to changes in atmospheric pressure with optic nerve compression due to sphenoidal sinus air dilatation. Moreover, particular emphasis has been attributed to PSD as an early sign of optic canal meningioma, [1][2][3][4][5] where the expansion of the sphenoid sinus is frequently accompanied by a thickening of the bone overlying the blistering.…”

Section: Discussionmentioning

confidence: 98%

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Neuro-ophthalmological presentation of pneumosinus dilatans

Carta

Castelnuovo

Delitala

1999

Neuro-Ophthalmology

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Pneumosinus dilatans (PSD) is a rare disease characterized by an abnormal expansion of an air-filled paranasal sinus. Because of the pressure effect on the adjacent structures, PSD may present with several neurological signs, the ocular ones being the most common. In the present study, we describe a case of frontal PSD with diplopia, proptosis, ophthalmoplegia, and compressive optic neuropathy. Imaging showed a large amount of air in the right orbit continuous with the ipsilateral frontal sinus. Endoscopic sinus surgery was performed to eliminate a valve-like mechanism created by an increased pneumatization of the Agger nasi cell above the ostium frontalis. Surgery was effective in restoring the normal communication between the sinus and the nasal cavity, thus resulting in full recovery of severe visual impairment. The distinction between PSD, pneumocele, and hypersinus is an important one since these disorders share some clinical features, but require different treatments. PSD visual prognosis is mainly related to its associated syndromes and their surgical treatment. If PSD occurs as an idiopathic disorder with simple sinus expansion, visual prognosis is good when appropriate surgery is performed. At present, endoscopic sinus surgery is preferable to the external approach for treatment of PSD.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 98%

Neuro-ophthalmological presentation of pneumosinus dilatans

Carta

Castelnuovo

Delitala

1999

Neuro-Ophthalmology

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show abstract

“…Some authors have postulated the theory of a one-way valve, which would allow the aeration of the sinus, creating a pressure gradient, and thereby increasing the outward pressure on the sinus wall. 12–14 This hypothesis may well explain the enlargement of the whole sinus. Conversely, a ‘negative pressure’ mechanism might be advocated to elucidate a focal bulging involving only the portion of the sinus adjacent to the meningioma, as in the case of our patients.…”

Section: Discussionmentioning

confidence: 98%

Sphenoidal pneumosinus dilatans due to anterior skull base meningiomas – CT and MRI aspects: Report of two new cases and literature review

et al. 2016

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“…Various theories have been proposed for the origin of PSD. The most accepted theory describes a one-way valve mechanism that obstructs sinus outflow, leading to air-trapping and chronic expansion [2,10]. Another theory proposes that chronic sinus inflammation may cause PSD by inducing sinus aeration; this suggestion is supported by the presence of chronic inflammatory markers in the mucosa of the sinus in some reported cases [7,9].…”

Section: Discussionmentioning

confidence: 99%

Surgical implications of frontoethmoidal pneumosinus dilatans-associated proptosis caused by meningioma

et al. 2016

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Pneumosinus dilatans (PSD) involves paranasal sinus enlargement without radiologic evidence of localized bone destruction, hyperostosis, or mucous membrane thickening. We discuss the surgical implications of PSD-associated proptosis in patients with anterior skull-base meningioma. A 20-year-old man with proptosis, hypoglobus, and lateral globe displacement had WHO grade I anterior skull-base and orbital meningiomas. Aggressive resection using anterior/medial orbitotomy and an anterior interhemispheric skull-base approach achieved Simpson grade I resection. Postoperatively, his symptoms improved, with no recurrence at 2-year follow-up. Although PSD-associated proptosis is relatively uncommon, it carries important clinical implications in surgical management of skull-base and orbital meningiomas.

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Temporary Unilateral Amaurosis with Pneumosinus Dilatans of the Sphenoid Sinus

Cited by 23 publications

References 28 publications

Neuro-ophthalmological presentation of pneumosinus dilatans

Neuro-ophthalmological presentation of pneumosinus dilatans

Sphenoidal pneumosinus dilatans due to anterior skull base meningiomas – CT and MRI aspects: Report of two new cases and literature review

Surgical implications of frontoethmoidal pneumosinus dilatans-associated proptosis caused by meningioma

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