Transsphenoidal endonasal Endoscopic decompression of superior orbital fissure syndrome

1. Pansinusitis,
cavernous sinus
thrombosis
Endonasal Endoscopic Decompression

2. PATIENT PARTICULARS
• Name : Abdul Jalil
• Age : 70
• Address :
• Diabetic
• Non- Hypertensive.

3. PRESENTING
COMPLAINTS
• Blurring of vision for 3 weeks
• Drooping of left upper eyelid.
• Proptosis of left eyeball.
• H/O Fever for past 2 months but afebrile for last15 days.
• Persistent headache.

4. EXAMINATION FINDINGS
• GCS- 15/15
• Left sided total ophthalmoplegia.
• Left sided Complete Ptosis.
• Visual acuity:
• Right- Reduced (finger counting possible)
• Left – Absent ( No PL/PR)
• Fundoscopy – Left eye- Early Optic atrophy
• Temperature - Normal

5. RADIOLOGICAL
FINDINGS
• MRI of orbit ē PNS :Chronic Inflammatory Lesion in left
parapharyngeal space extended upto Left Cavernous
Sinus ē Abscess formation. Pansinusitis.

8. • Debriding the sinuses
• Evacuation of “fungal
ball” like structure
• Drilling of the Sphenoid
sinus
• Decompressing Superior
orbital fissure and Optic
canal
• Opening the cavernous
sinus and
decompression.

9. POST OPERATIVE MRI

11. HISTOPATHOLOGY
• Chronic Non-specific Sinusitis. No Malignancy.
• Fungal culture yielded no growth.
• Bacteriological Studies revealed following organisms:
• MRSA
• Pseudomonas spp.
• Enterococcus spp.

12. POST OPERATIVE
TREATMENT
• Patient was on Intravenous Antibiotics and antifungal
drugs for 2 weeks.
• Ophthalmoplegia Improved.
• Ptosis improved.
• Visual acuity is improving.

13. 18TH POD

14. Thank you