Endoscopic transethmoidal sphenoidotomy

Abstract

The posterior ethmoid and sphenoid sinuses often have significant anatomic variation resulting in operative challenges for the endoscopic surgeon. The hazards of surgery in this region are serious. Complications such as optic nerve and/or orbital trauma, and cerebrospinal fluid leak still occur despite increasing training and experience. Factors that lead to surgical complications include the lack of orientation within the dissection field and/or impaired visualization. Because minimally invasive sinus surgery is now being performed more frequently, surgical techniques designed to reduce the risk of complications are more important than ever. Anatomic landmarks that reliably orient the dissection within the posterior ethmoids and guide the surgeon to the sphenoid sinus could reduce such adverse outcomes. As with any surgical approach, it is better to rely on consistent anatomic landmarks within the operative field to perform the surgery safely, rather than rely on a range of measurements or adjunctive radiographic techniques, as described in many prior reports. The superior meatus and superior turbinate, skull base, and medial orbital wall are relatively reliable landmarks within the dissection field that can orient the surgeon. These anatomic landmarks allow safe dissection within the posterior ethmoid and a reliable approach to the sphenoid sinus, especially in patients undergoing revision surgery or in those with anatomic variations. The authors present their technique for the transethmoidal approach to the sphenoid sinus and discuss its advantages.