Sphenoid sinus cyst with bone destruction of the skull base – case report

The aim of this paper is to present the case of a 62-year-old man with a sphenoid sinus cyst with skull base destruction. He was admitted to hospital with severe headache, visual disturbance, left ear conductive hearing loss, and loss of weight. The complaints had been increasing over the last two years. The diagnosis of the sphenoid sinus cyst with the sella turcica destruction was established two years ago but the patient refused treatment. On admission, the CT revealed a pathological mass in the left sphenoid sinus (density of 48 HU, size of 33x25x25 mm), causing extensive destruction of its left and upper walls with penetration into the skull. MRI confirmed the presence of a 28x24-mm cyst which was adjacent to the bottom of the sella and did not penetrate to the brain. In addition, the studies revealed chronic sinusitis with polyps. The patient was treated by endoscopic sinus surgery under navigation system. Wide marsupialization of the frontal wall of the sphenoid sinus cyst and removal of the polypoid changes were carried out. Pain subsided after surgery. A control MRI revealed thickening of the mucous membranes of the ethmoid, sphenoid, and maxillary sinuses, and the left mastoid cells. Moreover, no evidence of invagination of the meninges within the operated area was stated.