CASE REPORT
Objetivo: Relatar um caso raro de Pneumosinus Dilatans (PSD) associado a um meningioma de tubérculo selar, destacando suas características clínicas e radiológicas, manejo cirúrgico e desfechos. Métodos: Paciente do sexo feminino, 30 anos, com história de 12 meses de perda progressiva do campo visual no olho esquerdo, resultando em cegueira. O exame neurológico não foi notável, exceto pelo déficit visual. Estudos de imagem, incluindo tomografia computadorizada e ressonância magnética, revelaram hiperostose e aumento significativo do seio esfenoidal sem defeitos ósseos (consistentes com PSD), além de um tumor de tubérculo selar. O paciente foi submetido a craniotomia pterional com ressecção microcirúrgica do tumor e descompressão do nervo ótico. A análise histopatológica confirmou o diagnóstico de meningioma. Resultados: A avaliação pós-operatória demonstrou preservação da função muscular ocular extrínseca, confirmando a integridade cirúrgica dos nervos oculomotor, troclear e abducente. No entanto, devido à duração prolongada da deficiência visual pré-operatória, a visão do paciente não se recuperou totalmente. Conclusões: Este caso ressalta a importância da deteção e intervenção precoces em pacientes com DSP, particularmente quando associados a meningiomas da base anterior do crânio. A descompressão precoce do nervo óptico pode melhorar os resultados visuais, e os médicos devem manter um alto índice de suspeita de DSP em pacientes que apresentam perda visual progressiva. Métodos de rastreio simples, como radiografias de crânio, podem facilitar o diagnóstico precoce, permitindo assim um tratamento imediato e potencialmente melhores prognósticos.
Objective: To report a rare case of Pneumosinus Dilatans (PSD) associated with a meningioma of the tuberculum sellae, highlighting its clinical and radiological features, surgical management, and outcomes. Methods: A 30-year-old female presented with a 12-month history of progressive visual field loss in her left eye, ultimately resulting in blindness. Neurological examination was unremarkable except for the visual deficit. Imaging studies, including computed tomography and magnetic resonance imaging, revealed hyperostosis and significant enlargement of the sphenoid sinus without bony defects (consistent with PSD), in addition to a tumor in the tuberculum sellae. The patient underwent a pterional craniotomy with microsurgical resection of the tumor and decompression of the optic nerve. Histopathological analysis confirmed the diagnosis of meningioma. Results: Postoperative evaluation demonstrated preserved extrinsic ocular muscle function, confirming the surgical integrity of the oculomotor, trochlear, and abducens nerves. However, due to the prolonged duration of preoperative visual impairment, the patient’s vision did not fully recover. Conclusions: This case underscores the importance of early detection and intervention in patients with PSD, particularly when associated with anterior skull base meningiomas. Early optic nerve decompression may improve visual outcomes, and clinicians should maintain a high index of suspicion for PSD in patients presenting with progressive visual loss. Simple screening methods, such as skull radiographs, can facilitate early diagnosis, thereby enabling prompt treatment and potentially better prognoses.
2. Urken ML, Som PM, Lawson W, Edelstein D, Weber AL, Biller HF. Abnormally large frontal sinus. II. Nomenclature, pathology, and symptoms. Laryngoscope. 1987;97(5):606-11. http://doi. org/10.1288/00005537-198705000-00014. PMid:3573909.
3. Zhou X, Xu Q, Zhang B, et al. Sphenoidal pneumosinus dilatans associated compressive optic neuropathy: a case series of four adolescent patients. Heliyon. 2024;10(20):e38763. http://doi.org/10.1016/j.
heliyon.2024.e38763. PMid:39640786.
4. Danassegarane G, Bretonnier M, Tinois J, Proisy M, Riffaud L. Sphenoid pneumosinus dilatans and visual loss: when should the optic nerve be decompressed? Childs Nerv Syst. 2021;37(8):2677-82. http:// doi.org/10.1007/s00381-020-04916-9. PMid:33145638.
5. EyeWiki. Neuro-ophthalmic manifestations of pneumosinus dilatans. EyeWiki; 2024. Available from: https://eyewiki.org/NeuroOphthalmic_Manifestations_of_Pneumosinus_Dilatans#cite_note:5-6. Accessed: 4/4/2024.
6. Nyalundja AD, Mugisha F, Karekezi C. The natural history and treatment of meningiomas: an update. Semin Neurol. 2024;44(1):1-15. http://doi.org/10.1055/s-0043-1777352. PMid:38052237.
7. Hirst LW, Miller NR, Allen GS. Sphenoidal pneumosinus dilatans with bilateral optic nerve meningiomas. A case report. J Neurosurg. 1979;51(3):402-7. http://doi.org/10.3171/jns.1979.51.3.0402. PMid:469587.
8. Lui YW, Dasari SB, Young RJ. Sphenoid masses in children: radiologic differential diagnosis with pathologic correlation. AJNR Am J Neuroradiol. 2011;32(4):617-26. http://doi.org/10.3174/ajnr.A2144. PMid:20595365.
9. Scuotto A, Saracino D, Rotondo M, et al. Sphenoidal pneumosinus dilatans due to anterior skull base meningiomas - CT and MRI aspects: report of two new cases and literature review. Neuroradiol
J. 2016;29(4):295-7. http://doi.org/10.1177/1971400916648336. PMid:27220845.
10. Kim WJ, Kim MM. Binasal hemianopia caused by pneumosinus dilatans of the sphenoid sinuses. Indian J Ophthalmol. 2019;67(10):17725. http://doi.org/10.4103/ijo.IJO_1580_18. PMid:31546562.
11. Danassegarane G, Bretonnier M, Tinois J, Proisy M, Riffaud L. Pneumosinus dilatans of the sphenoid and visual loss: when should the optic nerve be decompressed? Childs Nerv Syst. 2021;37(8):2677-82. http://doi.org/10.1007/s00381-020-04916-9. PMid:33145638.
12. Desai NS, Saboo SS, Khandelwal A, Ricci JA. Pneumosinus dilatans. J Craniofac Surg. 2014;25(2):418-21. http://doi.org/10.1097/ SCS.0000000000000694. PMid:24561372.
1Universidade Evangélica Mackenzie, Curitiba, PR, Brasil.
2Graduate Program in Principles of Surgery, Universidade Evangélica Mackenzie, Curitiba, PR, Brasil.
3INCT em Biologia do Câncer Infantil e Oncologia Pediátrica – INCT BioOncoPed, Porto Alegre, RS, Brasil.
4Centro Avançado de Neurologia e Neurocirurgia – CEANNE, Porto Alegre, RS, Brasil.
Received Feb 14, 2025
Accepted Mar 17, 2025
