Aspergillosis of the sphenoid sinus accompanied by right abducent nerve palsy and a bilateral defect of the lateral visual field

Abstract

A 70-year-old woman presented with the chief complaint of right abducent nerve palsy and a bilateral defect of the lateral visual field without any nasal symptoms. A computed tomographic examination revealed a soft density mass which occupied both sphenoid sinuses with partial calcification while also showing the skull base bone in the sinuses to be extensively defective. The patient underwent endoscopic sinus surgery to remove the diseased tissue endonasally. The sphenoid sinuses were marsupialized and irrigated with saline solution. The optic chiasm, dura mater and bilateral carotid arteries were observed during the operation. The patient's symptoms began to improve the day after operation. Her postoperative course has been uneventful for two years since then. A clear differentiation of non-invasive type mycosis from an invasive type is therefore essential in order to select the optimal treatment strategy. Our experience suggests that non-invasive type mycosis does not require a total removal of the involved structures.