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Timothy J McCulley, W Jordan Piluek; SPHENOID SINUS EXPANSION: A RADIOGRAPHIC SIGN OF INTRACRANIAL HYPOTENSION AND THE SAGGING BRAIN, SUNKEN EYES SYNDROME. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4074.
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"Sunken eyes, sagging brain syndrome" refers to a newly recognized syndrome characterized by intracranial hypotension and consequent enophthalmos from orbital volume expansion. To test the hypothesis that bone remodeling is not limited to the orbits, in this study volumetric analysis of the sphenoid sinus is performed.
In this university based retrospective case controlled study the dimensions of the sphenoid sinus were measured in four patients (2 males, 2 females, mean age 26.3 years, range 16 to 38 years) out of five individuals identified with sagging brain, sunken eyes syndrome. Three measurements were taken: the distance between the orbital apices, the posterior extension of the sphenoid sinus posterior to the orbital apices and the maximal horizontal width. The mean of each was determined and compared to that of the control group (5 males, 5 females, mean age 35.6 years old, range 23 to 45 years).
Posterior extension and width of the sphenoid sinus were markedly larger in the enophthalmic than the control group: posterior extension (26.3+4.1mm vs. 13.4+6.3mm, p=0.0015, student’s t-test), width (39.2+8.7mm vs. 25.1+6.9mm, p=0.0035, student’s t-test). Mean distance between the orbital apices was slightly greater (36.3+1.7mm vs. 34.1+2.1mm, p=0.047, student’s t-test).
Skull remodeling occurring in association with intracranial hypotension after VPS is not limited to the orbits. In this study we have demonstrated expansion of the sphenoid sinus. This finding adds to our knowledge and understanding of the scope of the sagging brain, sunken eyes syndrome and elucidates a clinically useful radiographic sign.
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