Sphenoid sinus pyocele with intracranial extension managed under endoscopic guidance: a report of an extremely rare case.

OBJECTIVES

Sphenoid pyoceles with intracranial extension are extremely rare lesions that can mimic tumours and usually cause ophthalmological symptoms. Their infectious nature mandates urgent surgical decompression since pyoceles can cause intracranial and orbital complications.

CASE REPORT: A 16-year-old male presented with intense headache and dizziness lasting three days. On admission, the patient gave a five-year history of chronic rhinitis, nasal congestion, and progressively worsening headaches. Ophthalmological examination was normal. CT and MR scans disclosed distension of the sphenoid sinus by a pyocele 55 mm in diameter, extending to the presellar region through the eroded cribriform plate. The patient underwent an endoscopic transnasal sphenoethmoidectomy. After surgery he reported improvement in all preoperative symptoms and was asymptomatic at 3-months follow-up.

CONCLUSIONS

A huge sphenoid sinus pyocele with intracranial extension may cause no ophthalmological symptoms. It can be safely managed using endoscopic techniques.