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INTRODUCTION. Isolated sphenoid sinus disease is a rare condition due to the topographic location of the sinus. In complicated cases and the occurrence of a chronic course, the main method of treatment is surgical cure. There are different approaches to the main sinus, the most effective and safest is endoscopic endonasal sphenotomy. However, in cases of anomalies or disorders of the development of the sphenoid sinuses, as well as the need for combined operations, the transeptal approach may be the method of choice.OBJECTIVE is to evaluate the effectiveness and security of the proposed access.METHODS AND MATERIALS. A prospective analysis was carried out of 52 patients who underwent surgical treatment of isolated sphenoiditis at the Clinic of Otorhinolaryngology of the Pavlov State Medical University in the period from 2018 to 2023.RESULTS. In 5 cases, the sphenoid sinus was opened by transseptal approach. As a result of the analysis of the two approaches, no statistically significant differences were found.CONCLUSIONS. Our surgical interventions with transseptal approach in patients with minor sphenoid sinuses, impaired course of the internal cerebral artery, as well as the need for simultaneous correction of the nasal septum revealed the advisability and effectiveness of approach in such situations, as well as its safety in relation to neurovascular structures.

Aim – to analyze the cases of isolated lesions of the sphenoid sinuses and to identify the main errors in the differential diagnosis in the prehospital and treatment periods. Material and methods. The study includes the data on the treatment of 58 patients with an isolated lesion of the sphenoid sinus in the period 2015–2018. The patients' age varied from 18 to 68 years. Gender distribution: men – 21 (30.7%), women – 37 (69.3%). Results. The following surgical approaches were used: transnasal access, extended transnasal access, transetmoid access, access according to the Bolger Box technique. In one case, the transpterygoid approach was used. When performing extended access, it was possible to achieve the formation of persistent, epithelized anastomosis in all the cases. In polypous-purulent forms of sphenoiditis, the relapses of the disease were most often observed, however, only anti-inflammatory therapy was required, including a sinus irrigation through the formed anastomosis. Conclusion. Further studies are required, to examine the features/safety and clinical efficacy of the various endosurgical approaches.

The morphometric parameters of the sphenoid sinus are used to describe the normal anatomy of the sphenoid sinus as a whole, as well as in clinical medicine when planning surgical operations as the data defining the tactics and the operational benefits. The purpose of this review is to identify the informative morphometric parameters of the sphenoid sinus and skull as a whole and update the default values that are used in neurosurgical operational interventions on the sphenoid sinus. The analysis of the literature reveals the absence of the main approaches to the description of quantitative anatomy of the sphenoid sinus. In theoretical terms, morphometry is used to quantify the sinuses. A separate item is the study of the topography and pneumatization near lying anatomical structures. However, the implementation of ENT and endoscopic surgery, in choosing transsphenoidal accesses sella and related anatomical regions is necessary to study the quantitative anatomy of the sphenoid sinus, informative indicators are: the height and the width, length and type of pneumatization, the size of the lines (Zuckerkandl) access to the front and the rear wall of the sinus. Besides, the literature does not particularly marked variability of said morphometric characteristics depending on the shape of the skull, sex, age. These data suggest the need for a deeper study of the quantitative characteristics of the main sinus sex and age aspects. As a method for studying the high reliability offered for practical use of CT. [ABSTRACT FROM AUTHOR]

The aim of the study was to identify the features of diagnosis and treatment of sphenoid sinus diseases in patients over 60 years old. Clinical manifestations, results of endoscopic and radiological examination methods, and surgical intervention tactics were compared between elderly patients and younger patients (aged 18-59 years) who sought treatment for sphenoiditis in I.P.Pavlov Saint-Petersburg First State Medical University. The study analyzed 51 patients with isolated sphenoid sinus pathology, of which 9,8% were over 60 years old. The most common symptom in elderly patients was headache. Surgical treatment was required in 80% of patients over 60 years old. Endoscopic endonasal surgery of the sphenoid sinus can be safely performed by a specialized surgical team in patients over 60 years old with low anesthesiological risk. The results of our study showed that there were no statistically significant differences in the length of hospital stay between patients in both groups. This indicates that caring for elderly patients with sphenoid sinus pathology does not necessarily lead to prolonged hospitalization or increased economic burden on healthcare systems. Further research is needed to better understand the causes of the disease and to develop more effective approaches to the diagnosis, therapy, and prevention of sphenoid sinus pathology in elderly people.

This article presents an analytical review of scientific publications on the topic of surgical treatment of isolated lesions of the sphenoid sinus. The publications, research data presented in the RSCI database, PubMed in the period 1985-2021 are analyzed. The selection of the material was carried out according to the keywords: sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis, endoscopic sphenotomy, relapses of sphenoiditis, sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis.

Features of the location of the sphenoid sinus determine the possibility of developing severe intraoperative complications in the surgical treatment of patients with chronic sphenoiditis. Technical difficulties during sphenoidotomy may arise at the initial stage of expansion of the natural anastomosis with its anatomical narrowness and the impossibility of inserting biting forceps., Purpose of the Study: To study the clinical efficacy and safety of the proposed original method of dilatation of the sphenoid sinus fistula in the surgical treatment of various forms of chronic sphenoiditis., Material and Methods: The study included 68 patients of both sexes older than 18 years with chronic sphenoiditis, who are indicated for surgery on the sphenoid sinus. Patients of the 1st group ( n =36) underwent expansion of the fistula of the sphenoid sinus using the traditional method. Patients of the 2nd group ( n =32) underwent dilatation of the anastomosis of the sphenoid sinus using the tool developed by us. Intraoperatively, the quality of visualization of the surgical field, the time of the operation, and the presence of complications were assessed. In the postoperative period, the number of complications, relapses of the disease and the condition of the sinus were recorded according to the results of computed tomography 3-4 months after the operation., Results: The use of the method of dilated expansion of the anastomosis of the sphenoid sinus using special forceps developed by us helps to reduce the duration of the operation, improve intraoperative visualization of the sphenoid sinus and improve the results of treatment according to endoscopy and control computed tomography. When using the developed tool, the number of episodes of intraoperative bleeding that hindered visualization and necessitated coagulation was lower than when using an alternative technique., Conclusion: The technique of endoscopic dilatation of the anastomosis of the sphenoid sinus using the developed tool can be used both independently and as a preliminary step for expanding the anastomosis of the sphenoid sinus, followed by the use of a shaver or Kerrison forceps.

Isolated sphenoid osteomas are very rare even in adults. There are extremely few publications on pediatric cases of sphenoid osteomas. This paper presents a case of isolated sphenoid osteoma combined with suppurative sphenoiditis in a 15-year-old patient. The child presented with persistent headache resistant to medical treatment. Endoscopic sphenotomy allowed both to remove osteoma and to relieve the symptoms of sinusitis. The presented case can be considered as the third detailed description of the sphenoid osteoma in children and the first demonstration of the effectiveness of the endoscopic approach for its removal.

Objective: Determine the influence of the anatomical features and sizes of the lateral pocket with a defect on the choice of surgical access and the quality of the performed plastics., Material and Methods: A retrospective analysis of computed tomograms of 38 patients who underwent surgical treatment at the Burdenko National Medical Research Center for Neurosurgery of the Ministry of Health of Russia about defects of the skull base in the area of the lateral pocket of the sphenoid sinus. The patients were divided into three groups depending on the approach used (the 1st group), the recurrence rate (the 2nd group), and the characteristics of intraoperative visualization of the defect (the 3rd group)., Results: There were no statistically significant differences in anatomical features in patients who underwent trans-pterygoid and transsphenoidal approaches, as well as in patients of the 2nd group. Patients of the 3rd group (with visualization features) showed statistically significant differences between the distance from the defect to the VR line ( p =0.007). In patients with good visualization of the defect using direct optics, this distance was shorter than in patients in whom the defect was visualized with an angled endoscope. No other anatomical differences were noted., Conclusions: The anatomical features of the lateral pocket structure (type of pneumatization, size and volume) did not affect the choice of access to the defect and the frequency of recurrence. When comparing the approaches, it was noted that the trans-pterygoid access, providing direct visualization of defects, minimizes the risk of recurrence in the postoperative period. An objective anatomical indicator for choosing an access to the defects of the lateral pocket can be the distance from the defect to the VR line: at a distance of more than 0.7 cm, it is advisable to perform a trans-pterygoid approach; at a distance of less than 0.7 cm, it is possible to achieve direct visualization of the defect and perform high-quality plastic surgery with a transsphenoidal access.

Aim: To clarify the concept of 'aggressive pituitary adenoma' using analysis of the current concepts, as well as to determine the optimal treatment algorithm for this disease and the place of chemotherapy in this treatment. Pituitary adenomas comprise from 10 to 15% of intracranial neoplasms. Despite the fact that pituitary adenomas are benign neoplasms, in 25-55% of cases they demonstrate invasive growth, growing into the surrounding structures (sphenoid sinus, cavernous sinus, etc.). Due to the lack of a standard definition of aggressive pituitary adenomas (due to the lack of clear criteria for this disease), there are no studies in the literature reporting optimal treatment for this group of patients, except for several publications describing the use of Temozolomide as palliative therapy.

Meningoencephalocele is a hernial protrusion of the medulla and meninges through a defect in the skull bones. Due to poor accessibility of meningoencephalocele located in the lateral sphenoid recess region, modern surgical treatment of this pathology prefers to use endoscopic transsphenoidal approaches., Material and Methods: The study included 4 patients with meningoencephalocele of the lateral recess of the sphenoid sinus (1 male and 3 females; mean age, 46.8 years). All patients underwent resection of meningoencephalocele and repair of a skull base defect using the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach)., Results: In all patients, meningoencephalocele was resected to the bone defect level. There was no postoperative liquorrhea. Complications included bacterial meningitis (1 case), asymptomatic imbibition of the temporal lobe pole (1 case), and temporary numbness in the V 2 innervation area of the trigeminal nerve (1 case)., Conclusion: The paper describes and demonstrates advantages of the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach) for surgical treatment of patients with meningoencephalocele of the lateral sphenoid recess.

According to various authors, the rate of sphenoid sinus defects ranges from 15 to 26%. In the sphenoid sinus, the most common defect localization is the lateral recess - 35.3%. Regardless of the etiology and pathogenesis of lateral sphenoid sinus recess cerebrospinal fluid (CSF) leak, the treatment approach is aimed at plastic closure of the defect. Surgery in this area is associated with a high rate of recurrences (25%) due to a complex anatomical landscape and inapplicability of a direct approach., Purpose: The study purpose was to analyze our own experience in treating patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess and, based on the obtained results, develop an algorithm for the treatment of this pathology., Material and Methods: We retrospectively reviewed a series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess who were treated at the Burdenko Neurosurgical Institute in the period between 2001 and 2017. The demographic characteristics of patients, clinical data, and aspects of surgical treatment were analyzed. Treatment outcomes were assessed based on analysis of recurrences and postoperative complications. The obtained data were compared to the literature data., Results: In the series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess, the mean age was 49 years. Surgery through the transsphenoid approach was performed in 89 (74%) patients. There were 25 (28%) recurrences in this group. Nine (7%) patients underwent repair of a complex skull base defect using the transethmoidal approach; there were 3 (33%) recurrences. The transpterygoid approach was used in 22 (17%) patients; there were 3 (14%) recurrences in this group., Conclusion: Endoscopic endonasal repair is an effective technique for treating complex skull base defects in the lateral sphenoid sinus recess. The choice of an approach to the defect depends on the degree of pneumatization of the sphenoid sinus, surgeon's experience, and availability of the necessary equipment and tools. The endoscopic transpterygoid approach is advisable to use in cases of excessive pneumatisation of the sinus with developed lateral processes and recurrent nasal CSF leak. This enables visualization of the defect edges in this hard-to-reach area and adequate repair.

This article is designed to report the results of analysis of the literature publications concerning age-specific changes in the configuration of the sella turcica, frontal and sphenoid sinuses during the life span of a human being. It is shown that the subjects above the age of 20-25 years undergo age-dependent variations of the morphometric characteristics of the sella turcica, frontal and sphenoid sinuses. It suggests the necessity of the further development of the research methods with a view to increasing the number of techniques used in forensic medicine designed to enhance the accuracy of estimation of the human biological age.

The details are provided on the role of computed tomography (CT) in determination of indications for and scope of surgical interventions in polypous rhinosinusopathy, osteomas of the sphenoid sinus, total sequestration of the labyrinth, chronic otitis media purulenta invading the orbit and the brain. CT permitted optimal surgical intervention and prevention of serious postoperative complications.

The paper reports two rare cases of sphenoidal osteoma which occur statistically in 1.9% of sphenoidal osteomas. Two women underwent computed tomography because of complaints of progressive headaches. The patients had recurrent unilateral exudative otitis media. CT localized the tumor spread into the cerebral cranium and promoted further treatment design. The authors state that indications to CT diagnosis in patients with headaches should be increased. It is also suggested to make CT-diagnosis more frequently in cases of recurrent unilateral exudative otitis.

The results of surgical treatment of 550 patients through a transnasosphenoidal approach are analysed. The results of management of endosellar and endoextrasellar adenomas are discussed. Various groups of patients are set apart according to the hormonal activity of the tumor. The indications and contraindications for operations through a transnasosphenoidal approach are specified beforehand. The complications in transnasal operations are described and mortality is analysed.

203 patients with juvenile angiofibroma of the base of the skull were assessed clinicoanatomically. In addition to a routine otorhinolaryngological examination 60 patients underwent computed tomography, radioangiography and thermography. Biopsy specimens obtained at operations were studied morphologically for 133 patients including application of histotopography in 15 cases and electron microscopy in 19 cases. Two clinicoanatomic forms of juvenile angiofibroma (JAF) have been revealed as well as 4 vascular types and variegation due to different combinations of vascular, cellular and fibrillar components. According to biologic nature of JAF it should be referred to fibromatoses.