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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2017; 78(03): e97-e100
DOI: 10.1055/s-0037-1600916
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Complex Frontal Pneumosinus Dilatans Associated with Meningioma: A Report of Two Cases and Associated Literature Review

Sara Timms
1   Department of Rhinology, Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
,
Raj Lakhani
1   Department of Rhinology, Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
,
Steve Connor
1   Department of Rhinology, Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
,
Claire Hopkins
1   Department of Rhinology, Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
› Author Affiliations
Further Information

Publication History

12 August 2016

18 January 2017

Publication Date:
25 July 2017 (online)

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Abstract

Introduction Pneumosinus dilatans (PSD) is a rare phenomenon involving the expansion of the paranasal sinuses, without bony destruction or a mass. Previously documented cases have demonstrated simple expansion of a solitary air cell. We present two unique cases of PSD in the presence of meningioma, in which complex new cells developed within the frontal sinus. One of the two patients developed associated sinus disease.

Case 1 A 28-year-old man presented with facial pain. A computed tomography scan showed an abnormally enlarged, septated right frontal sinus, not present on childhood scans. He underwent a modified endoscopic Lothrop approach to divide the septations, and his symptoms resolved.

Case 2 A 72-year-old woman presented with a 3-month history of headaches. Scans revealed a left frontal meningioma and multiple enlarged, dilated left frontal air cells. She had no clinical sinusitis and therefore was managed conservatively.

Conclusions PSD has been widely documented in association with fibrous dysplasia and meningioma. The most prevalent theory of the mechanism of PSD is of obstruction of the sinus ostium causing sinus expansion through a “ball-valve” effect. Our cases, which demonstrate septated PSD, suggest a more complex process involving local mediators and highlight the need to consider underlying meningioma in pneumosinus dilatans.

Keywords

pneumosinus dilatans - meningioma - rhinosinusitis - etiology
 

  • References

  • 1 Miller NR, Golnik KC, Zeidman SM, North RB. Pneumosinus dilatans: a sign of intracranial meningioma. Surg Neurol 1996; 46 (05) 471-474
    CrossrefPubMedGoogle Scholar
  • 2 Gibbons BA, Miele WR, Florman JE, Heilman CB, Horgan MA. Pneumosinus dilitans and meningioma: a case series and review of the literature. Neurosurg Focus 2011; 30 (05) E13
    PubMedGoogle Scholar
  • 3 Adams WM, Jones RI, Chavda SI, Pahor AL, Taifa KT. Pneumosinus dilatans: a discussion of four cases and the possible aetiology. Rhinology 1998; 36 (01) 40-42
    PubMedGoogle Scholar
  • 4 Parizel PM, Carpentier K, Van Marck V. , et al. Pneumosinus dilatans in anterior skull base meningiomas. Neuroradiology 2013; 55 (03) 307-311
    CrossrefPubMedGoogle Scholar
  • 5 Lumenta CB, Di Rocco C, Haase J, Mooij JJA. Neurosurgery. Heidelberg. Germany: Springer; 2010: 96
    Google Scholar
  • 6 Benjamins CE. Pneumosinus frontalis dilatans. Acta Otolaryngol 1918; 1: 412-444
    CrossrefPubMedGoogle Scholar
  • 7 Lloyd GA. Orbital pneumosinus dilatans. Clin Radiol 1985; 36 (04) 381-386
    CrossrefPubMedGoogle Scholar
  • 8 Duque CS, Casiano RR. Surgical anatomy and embryology of the frontal sinus. In: Kountakis SE, Senior BA, Draf W. , eds. The Frontal Sinus. Heidelberg. Germany: Springer; 2005: 21-31
    Google Scholar
  • 9 Urken ML, Som PM, Lawson W, Edelstein D, Weber AL, Biller HF. Abnormally large frontal sinus. II. Nomenclature, pathology, and symptoms. Laryngoscope 1987; 97 (05) 606-611
    PubMedGoogle Scholar