A 50-year-old woman visited out-patient clinic of neurology because of 1 year intermittent sharp pain on the left head and face, aggravating within 15 days. In the past 1 year, headache occurred every day and lasted for 3–4 h, symptom was worse at day time, particularly after bending. There was no nausea and vomiting. Gradually, pain localized on left cheek, accompanying with left superior teeth and eye pain. She was treated with Vitamin B1, Mecobalamin and Carbamazepine, but without relief. There was clear tenderness on the position of left supraorbital nerve and infraorbital nerve. She was preliminarily diagnosed as trigeminal neuralgia and was admitted in the Neurology Department. Enhanced brain MRI showed left sphenoid sinusitis with mucoceles, but without any abnormal alteration in brain parenchyma. Consultation of ENT doctor suggested to perform paranasal sinus CT scan. It demonstrated that left sphenoid sinusitis with abnormal intensity of soft tissue, absorbent thinning of front sinus wall, bone hyperplasia of side and rear sinus wall. Then, this patient was referred to the Otolaryngology Department. Patient was treated by transnasal endoscopic sphenoidotomy without antifungal therapy. Histopathological examination diagnosed left sphenoid sinus as SSFB. No further recurrence of her headache was found after 4 years follow-up.
A 66-year-old woman was admitted in the Neurology Department because of 2 month repeatedly headache, aggravating within 1 week. The localization of headache was mainly on left side of forehead, tempus, and cheek. It showed as intermittent pain, worse in the morning and tended to aggravate when she lowered her head. 1 week before she was admitted in hospital, headache was persistent accompanied by upper teeth pain on left side. She had hypertension (blood pressure 177/88 mmHg) and occasional nasal bleeding. There was no positive symptoms in nervous system. Brain CT imagine showed scattered demyelination in white matter of both frontoparietal lobes and inflammation in the left maxillary and sphenoid sinus. Further enhanced Brain MRI also demonstrated scattered demyelination in white matter of both frontoparietal lobes, inflammation of paranasal sinuses, and mucoceles in the left sphenoid sinus. Then, this patient was referred to the Otolaryngology Department. Further paranasal sinus CT demonstrated abnormal intensity of soft tissue in left sphenoid sinus, protrusion to the sinus cavity with nodular calcification. Patient was treated by transnasal endoscopic sphenoidotomy without antifungal therapy. Histopathological examination diagnosed left sphenoid sinus as SSFB. Follow-up of 10 months demonstrated no further recurrence of her headache.