双重医源性筛-眶-额窦黏液囊肿：神经导航系统在内镜鼻窦手术翻修中的作用——一例病例报告

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中文摘要

背景与临床意义： 额窦疾病因其复杂多变的解剖结构及术后易发生狭窄的高倾向性，仍是鼻科学中最具挑战性的疾病之一。鼻旁窦黏液囊肿是功能性内镜鼻窦手术（FESS）后不常见的迟发性并发症，最常累及额窦或前筛窦。其可能源于自然引流通道的阻塞或瘢痕形成，导致复发性鼻窦炎或头痛；病例介绍：一名21岁男性在既往两次FESS手术后出现持续性左侧额部头痛和鼻塞。影像学上，CT和MRI显示慢性左侧鼻窦炎症性疾病及两个额-筛窦黏液囊肿。采用图像引导（神经导航辅助）技术行翻修性内镜鼻窦手术，包括Draf IIb额窦开放术、黏液囊肿造袋术及矫正性鼻中隔成形术。术后过程平稳，临床迅速改善；结论：ESS后双重术后黏液囊肿罕见。神经导航辅助翻修手术可用于瘢痕化、解剖变形的鼻窦区域的有效处理。然而，本单例无法确立其优于传统内镜引导，也无法证明其对安全性、有效性或复发的影响。

英文摘要

Background and Clinical Significance: Frontal sinus disease remains one of the most challenging conditions in rhinology due to its complex and variable anatomy and high tendency toward postoperative stenosis. Paranasal sinus mucoceles are uncommon, delayed complications following functional endoscopic sinus surgery (FESS), most often involving the frontal or anterior ethmoidal sinuses. They may arise from obstruction or scarring of natural drainage pathways, producing recurrent sinusitis or headache; Case Presentation: A 21-year-old male presented with persistent left-sided frontal headache and nasal obstruction after two previous FESS procedures. Radiologically, CT and MRI demonstrated chronic left-sided sinonasal inflammatory disease and two frontal-ethmoidal mucoceles. Revision endoscopic sinus surgery was performed with an image-guided (neuronavigation-assisted) technique, including Draf IIb frontal sinusotomy, mucocele marsupialization, and corrective septoplasty. The postoperative course was uneventful with rapid clinical improvement; Conclusions: Double postoperative mucoceles following ESS are rare. Neuronavigation-assisted revision surgery can be used for effective management in scarred, anatomically distorted sinus regions. However, this single case cannot establish superiority over conventional endoscopic guidance or demonstrate an effect on safety, efficacy, or recurrence.