Abstract
Sphenoid sinus surgery is an important component of the management paradigm of inflammatory sinus disease as well as integral to the approaches to the sellar and parasellar regions for skull base lesions. Given this dual perspective, the surgeon must carefully appraise the surgical goals in the setting of the patient’s anatomy and pathology. Successful surgery requires these considerations, in addition to knowledge of the variable anatomy and anatomic relationships in the region. While complications can occur in any surgical procedure, complications in this delicate region can be devastating and are best managed with prevention. If encountered, rapid identification and initiation of further diagnostic and/or therapeutic measures is critical. This chapter presents the various surgical techniques, considerations, and anatomic relationships that are necessary for the endoscopic sinus and skull base surgeon to master surgery within this critical region. Multiple different approaches for successfully finding the sphenoid ostium are also discussed. Understanding these key anatomic features allows surgical management of an array of extracranial and intracranial pathology. Careful preoperative clinical and radiographic examinations significantly aid the surgical approach and allow the surgeon to be proactive rather than reactive when addressing the area.
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References
Vidic B. The postnatal development of the sphenoidal sinus and its spread into the dorsum sellae and posterior clinoid processes. Am J Roentgenol Radium Ther Nucl Med. 1968;104(1):177–83.
Kennedy DW, Hwang PH. Rhinology: diseases of the nose, sinuses, and skull base. 1st ed. New York: Thieme Medical Publishers, Inc.; 2012.
Shah RK, Dhingra JK, Carter BL, Rebeiz EE. Paranasal sinus development: a radiographic study. Laryngoscope. 2003;113(2):205–9.
Hamberger CA, Hammer G, Norlen G, Sjogren B. Transantrosphenoidal hypophysectomy. Arch Otolaryngol. 1961;74:2–8.
Hamid O, El Fiky L, Hassan O, El Fiky S. Anatomic variations of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery. Skull Base. 2008;18(1):9–15.
Rhoton Jr AL. The sellar region. Neurosurgery. 2002;51(1):335–74.
Kennedy DW, Zinreich SJ, Hassab MJ. The internal carotid artery as it relates to endonasal sphenoethmoidectomy. Am J Rhinol. 1990;4(1):7–12.
Batra PS, Citardi MJ, Gallivan RP, Roh HJ, Lanza DC. Software-enabled computed tomography analysis of the carotid artery and sphenoid sinus pneumatization patterns. Am J Rhinol. 2004;18(4):203–8.
Woodworth BA, Ahn C, Flume PA, Schlosser RJ. The delta F508 mutation in cystic fibrosis and impact on sinus development. Am J Rhinol. 2007;21(1):122–7.
Shetty PG, Shroff MM, Fatterpekar G, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol. 2000;21(2):337–42.
Illing E, Schlosser RJ, Palmer JN, Cure J, Fox N, Woodworth BA. Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg’s canal. Int Forum Allergy Rhinol. 2014;4:246–50.
Stammberger HR, Kennedy DW. Paranasal sinuses: anatomic terminology and nomenclature. The Anatomic Terminology Group. Ann Otol Rhinol Laryngol Suppl. 1995;167:7–16.
Onodi A. The optic nerve and the accessory sinuses of the nose. New York: William Wood & Co; 1910.
Lore JM, Medina JE. An atlas of head & neck surgery. 4th ed. Philadelphia: Elsevier Saunders; 2005.
Bolger WE, Keyes AS, Lanza DC. Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus. Otolaryngol Head Neck Surg. 1999;120(3):308–13.
Teatini G, Simonetti G, Masala W, Decola GL. Computed tomography of the ethmoid labyrinth and adjacent structures. Ann Otol Rhinol Laryngol. 1987;96(3 pt 1):239–50.
Bansberg SF, Harmer SG, Forbes G. Relationship of the optic nerve to the paranasal sinuses as shown by computed tomography. Otolaryngol Head Neck Surg. 1987;96(4):331–5.
Dessi P, Moulin G, Castro F, et al. Protrusion of the optic nerve into the ethmoid and sphenoid sinus: prospective study of 150 CT studies. Neuroradiology. 1994;36:515–6.
Han JK, Becker SS, Bomeli SR, et al. Endoscopic localization of the anterior and posterior ethmoid arteries. Ann Otol Rhinol Laryngol. 2008;117:931–5.
Moeller CW, Welch KC. Prevention and management of complications of sphenoidotomy. Otolaryngol Clin North Am. 2010;43(4):839–54.
Soudry E, Turner JH, Nayak JV, Hwang PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg. 2014;150(5):730–8.
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McClurg, S.W., Thorp, B.D., Senior, B.A. (2015). Surgery for Sphenoid Sinus Disease. In: Batra, P., Han, J. (eds) Practical Medical and Surgical Management of Chronic Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-319-16724-4_27
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DOI: https://doi.org/10.1007/978-3-319-16724-4_27
Publisher Name: Springer, Cham
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