Optimal Approach to the Sphenoid Sinus: The Missed Guide

Abstract

Objective: To formulate an updated applicable algorithm for selection of the optimal surgical approach to the sphenoid sinus. Method: Retrospective review. The records of 63 patients who had undergone surgery for sphenoid sinus lesions, at Otolaryngology Department, Tanta University, between 2000 and 2009 were reviewed. Four different surgical approaches were identified: Endoscopic transnasal sphenoidotomy (TNS), endoscopic transethmoidal sphenoidotomy, endoscopic transpterygoid sphenoidotomy, and endoscopic transnasal sphenoidotomy with posterior septectomy. The approaches were compared in: mean age, preoperative imaging data, pathological diagnosis, percentage of revision procedures, and surgical complications. Results: TNS was the most commonly used approach (65%). Endoscopic transethmoidal sphenoidotomy was the second approach (25%). Endoscopic transpterygoid sphenoidotomy was used in 3%. It was used for management of lateral sphenoid recess lesions. Endoscopic transnasal sphenoidotomy with posterior septectomy was used in 6% for sellar, parasellar, and clival lesions. No major complications were committed. Conclusion: Selection of the appropriate approach to the sphenoid depends mainly on the disease extent displayed by preoperative imaging. The endoscopic transnasal approach was suitable for management of isolated sphenoid sinus lesions. Eendoscopic transethmoid approach was used for management of pansinus involvement. The endoscopic transpterygoid approach was used for dealing with lesions of the lateral sphenoid recess and the endoscopic transnasal sphenoidotomy with posterior septectomy was used for management of sellar, parasellar, and clival lesions.