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Pleomorphic adenoma is the most common benign salivary gland tumour of the head and neck region, most commonly seen in parotid glands. These may arise also from minor salivary glands of the upper aerodigestive tract comprises the upper lip, cheek, floor of the mouth and rarely from mucoserous glands in the nasal cavity and paranasal sinuses. A middle-aged man, who had undergone surgery for a nasal mass 14 years ago, presented with headache and visual complaints from a recurrent mass originating from the sphenoid sinus. Isolated sphenoid sinus space-occupying lesions have always been a diagnostic challenge. The mass was biopsied and diagnosed as pleomorphic adenoma on histopathology, and then excised endoscopically. Early and accurate diagnosis on a biopsy may result in complete excision of the tumour and prevent recurrence. The endoscopic route is preferred for surgical excision and the patient should be followed up clinically and radiologically to detect early recurrence.

Background The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. Methods For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. Results For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n = 3), inexpert (n = 3) and the entire group of observers (n = 6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. Conclusions The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.

Isolated sphenoid sinus disease is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurological and vascular structures nearby. Early recognition and treatment are critical to prevent the progression of the disease. We present a case of a 60-year-old woman with a history of severe left-sided headache, facial pain, diplopia and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. Magnetic resonance imaging revealed opacification in left sphenoid sinus with cavernous sinus/superior orbital fissure involvement consistent with left sphenoid sinusitis. She was then referred to the ear, nose and throat department and had endoscopic transnasal sphenoidotomy in theatre. Culture results showed Haemophilus influenza and fungal pseudohyphae. She recovered three months later after a course of antibiotics and antifungals. The onset of isolated sphenoid sinus disease is often insidious and the diagnosis of this condition remains a challenge. Magnetic resonance imaging and computed tomography remain the best diagnostic tools to recognise and manage this condition.

To study the utility of T2-weighted MRI sequences in the identification of the inferior intercavernous sinus (IICS), a potential source of bleeding during transsphenoidal surgery of pituitary adenomas.Pituitary sagittal T1W and coronal T2W MRI sequences were analyzed in 237 consecutive patients, after the exclusion of postoperative MRIs and those revealing an empty sella or a pituitary macroadenoma. Sphenoid sinus pneumatization was defined as incomplete (group 1) if it did not reach the nadir of the sella turcica, as complete (group 2) if it extended beyond the nadir of the sella or asymmetric (group 3), when only one side of the sinus was completely pneumatized.In Group 2 (70% of the patients), the IICS was rarely visualized on coronal T2W MRI (6/167 patients-3.6%), whereas in Group 1 it was identified in nearly all patients (55/57 patients - 96.5%, p 0.001). In Group 3, the IICS was only visible above the non-pneumatized part of the sphenoid sinus.The IICS can be identified on coronal T2W images in patients with an incompletely pneumatized sphenoid sinus, but very rarely in patients with a totally pneumatized sinus. This information can help to increase awareness among pituitary surgeons of the need to potentially manage IICS bleeding during transsphenoidal surgery in patients with an incompletely pneumatized sphenoid sinus.

Introduction The vidian canal acts as landmark for the identification of the petrous carotid artery, especially during extended endoscopic endonasal approaches in cranial base surgeries. In order to localize the canal and to understand the relationship of pneumatization of pterygoid process to the type of vidian canal, this study was designed. Objectives The objective was to describe the anatomical relationship of pneumatization of the pterygoid process with types of vidian canal. The length of vidian canal, relationship to medial plate of pterygoid process and relationship to the petrous part of internal carotid artery were evaluated. Methods Head computer tomography scans of 52 individuals for suspected paranasal pathology were studied. The degree of sphenoid sinus pneumatization, pterygoid process pneumatization and types of vidian canal (type 1, 2 and 3) were noted. The length of vidian canal, distance from the plane of medial pterygoid plate and relation of vidian canal to the junction of petrous and Gasserian (ascending) part of internal carotid artery was noted. Results 46 (92%) sphenoid sinuses were of the sellar variety. Out of 104 sides that were studied, 57 sides demonstrated a pneumatised pterygoid process and 47 were not pneumatised. In 49 sides (47.1%) the vidian canal was on the same plane as that of the medial pterygoid plate in the coronal section. The vidian canal partially protruded into the sphenoid sinus (type 2) was the most common type (50.9%), found both on right and left sides. There is a statistically significant association between the pterygoid process pneumatization and occurrence of type 2 and type 3 vidian canal configuration. The average length of the vidian canal was 16.16 ± 1.8 mm. In 96 sides, the anterior end of vidian canal was inferolateral to petrous part of internal carotid artery in the coronal plane. Conclusion Pneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration. Resumo Introdução O canal vidiano atua como ponto de referência para a identificação da artéria carótida petrosa, especialmente durante abordagens endoscópicas endonasais extensas em cirurgias de base do crânio. Este estudo foi projetado com o objetivo de localizar o canal vidiano e entender a relação da pneumatização do processo pterigoide sobre o tipo de canal. Objetivos Descrever a relação anatômica da pneumatização do processo pterigoide com os tipos de canal vidiano. Foram avaliados o comprimento do canal vidiano, a relação com a placa medial do processo pterigoide e com a porção petrosa da artéria carótida interna. Método Foram estudadas tomografias computadorizadas de 52 indivíduos submetidos a tomografia computadorizada de cabeça por suspeita de doença em seio paranasal. Foram observados o grau de pneumatização do seio esfenoidal, a pneumatização do processo pterigoide e os tipos de canal vidiano (Tipos 1, 2 e 3). Observou-se o comprimento do canal vidiano, a distância do plano da placa pterigoide medial e a relação do canal vidiano com a junção da porção petrosa e gasseriana (ascendente) da artéria carótida interna. Resultados Eram do tipo selar 46 (92%) seios esfenoidais. Dos 104 lados estudados, 57 eram do processo pterigoide pneumatizado e 47 não eram pneumatizados. Em 49 lados (47,1%), o canal vidiano estava no mesmo plano que o da placa pterigoide medial na seção coronal. O canal vidiano em protusão parcial no seio esfenoidal (tipo 2) foi o tipo mais comum (50,9%), encontrado nos lados direito e esquerdo. Houve uma associação estatisticamente significante entre a pneumatização do processo pterigoide e a ocorrência da configuração do canal vidiano tipo 2 e tipo 3. O comprimento médio do canal vidiano foi de 16,16 ± 1,8 mm. Em 96 lados, a extremidade anterior do canal vidiano era inferolateral à porção petrosa da artéria carótida interna no plano coronal. Conclusão A pneumatização do processo pterigoide indica a configuração do canal vidiano tipo 2 ou tipo 3.

Objectives: To compare the sphenoid volume between the genders and to analyse variations in septal insertions on bony wall of optic nerve and internal carotid artery. Methods: The prospective study was conducted from October 2020 to February 2021 at the Radiology Department of Dow University of Health Sciences, Karachi, and comprised paranasal sinus patients of either gender aged 20-60 without any bony deformity of sphenoid sinus who were analysed for sphenoid volume, number of septa and variable septal insertions using computed tomography of paranasal sinus. On the basis of septal insertions, the scans were categorised into Group 1 with no risky septal insertion, Group 2 with septal insertion on bony wall of optic nerve, Group 3 with septal insertion of internal carotid artery, and Group 4 with septal insertion on both optic nerve and internal carotid artery. Differences in sphenoid volume were analysed between males and females and among the four groups. Data was analysed using Graph Pad Prism 9. Results: Of the 300 patients, 171(57%) were males and 129(43%) were females. The overall mean age was 39.28±10.9 years. Multiple septa were found in 208(69.3%) of the sinuses. There were 129(43.7%) patients in Group 1, 34(11.3%) in Group 2, 119(39%) in Group 3 and 18(6%) in Group 4. Significant difference was found between volume and gender as well as among the four groups (p

Many surgical considerations exist for an endoscopic approach for pituitary surgery for a neurosurgeon. The neurosurgical approach to endoscopic pituitary dissection requires proper surgical planning and identification of relevant anatomic structures. With the introduction of endoscopic transsphenoidal pituitary surgery, better visualization and more intricate surgical resections are achieved. Whether performing this surgery solo or with an otolaryngologist, the neurosurgeon must consider multiple aspects for this surgical approach. This article focuses on the surgical considerations involving the anatomic regions of the sphenoid sinus and sellar region for endoscopic pituitary dissections.

We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA).During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre- and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three-dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross-Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino-Nasal Outcome Test-20 (SNOT-20), and visual analog scale (VAS) evaluation.The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P = .046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT-20, and VAS scores) (all P .05).Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re-operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA.4 Laryngoscope, 132:965-972, 2022.

(1) Background: For good surgical performance, sound knowledge of anatomy is required. Although the ethmoid air cells and sphenoid sinuses are subject to a high degree of variation, their possible extensions above the nasal fossa at the posterior end of the cribriform plate of the ethmoid bone (CPEB) were seemingly overlooked. (2) Methods: We retrospectively studied 162 case files from 55 male and 107 female cases, with ages varying from 42 to 80, which were scanned using Cone Beam Computed Tomography. (3) Results: In 56.17% of cases, an unpneumatized CPEB (type I) was found. Nasal roof recesses of ethmoidal origin (type II) were found at the posterior end of the CPEB in 20.37% of cases. Different types of sphenoidal pneumatizations of the posterior end of the CPEB (type III) were found in 22.83% of the cases. Onodi cells projected nasal roof recesses (type IV) in only 10 cases. In all types, nasal roof recesses were found either above the CPEB or within/underneath it. Moreover, such nasal roof recesses were found to be either unilateral, extended contralaterally, or bilateral. (4) Conclusions: As such recesses of the posterior CPEB, previously overlooked, belong to the posterior rhinobase, they should be carefully documented preoperatively to avoid unwanted surgical damage to the olfactory bulb or CSF fistula.

A 68-year-old Chinese man was found to have a lobular mass in the sphenoid sinus which extended to the clivus and the roof of the nasopharynx on a staging MRI scan performed for his high-grade parotid salivary duct carcinoma. Further positron emission tomography scan showed that this lesion was fluorodeoxyglucose (FDG) avid. This proved to be a diagnostic dilemma. The patient underwent a total parotidectomy, left selective neck dissection and a transphenoidal biopsy of his nasal lesion. Final histology revealed that this lesion was a synchronous ectopic sphenoid sinus pituitary adenoma (ESSPA). Initial differential diagnoses that were considered included a chordoma, metastatic carcinoma and nasopharyngeal carcinoma. However, an important differential with a neoplastic appearance and a tendency for positive FDG uptake is an ESSPA. It requires dedicated immunohistochemical staining to diagnose, and its mainstay of treatment is surgical excision.

This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS).Retrospective study.University hospital.This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton's types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated.The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group.Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Sphenoid sinus, located posterior to the nasal cavity, is difficult to reach for a surgery. Several operation procedures are available for sphenoidotomy, including endoscopic surgeries. Although the endoscopic sinus surgery is minimally invasive with low post-operative side effects, further optimization is required. Transnasal sphenoidotomy is a low invasive alternative to transethmoidal sphenoidotomy, but it still needs to be studied to understand its effects on the airflow pattern and the particle deposition. In this work, we simulated airflow and the micro-particle deposition in the nasal airway of a middle-aged man to investigate the change in particle deposition in the sphenoid sinus after virtual transnasal sphenoidotomy surgery. The results demonstrated that after transnasal sphenoidotomy, particle deposition in the targeted sphenoid sinus was an order of magnitude lower than that observed after virtual transethmoidal sphenoidotomy surgery. In addition, the diameter of the particles for the peak deposition fraction in the targeted sinus was shifted to smaller diameters after the transnasal sphenoidotomy surgery compared with that in the post-transethmoidal condition. These results suggest that the endoscopic transnasal sphenoidotomy can be a better procedure for sphenoid surgeries as it decreases the chance of bacterial contaminations and consequently lowers the surgical side effects and recovery time.

Background High-positioned and/or superoposteriorly directed anterior communicating artery aneurysms can be treated by direct clipping using the pterional (fronto-temporo-sphenoidal) approach. This procedure, however, requires stronger retraction of the frontal lobe. Hence, preservation of the prominent frontal bridging veins (FBVs) draining into the sphenoparietal sinus (SPS) remains a significant challenge in preventing postoperative venous congestion. Methods We developed a technique to release the tension on the FBVs by pulling them together with the SPS epidurally. In 2 patients, who had presented with high-positioned and/or superoposteriorly directed anterior communicating artery aneurysms, we peeled off the arachnoid surrounding the FBVs and detached it from the brain surface. We further released the veins by moving them posteriorly, together with the SPS epidurally. Results Using this technique, we established a wide corridor through a more lateral transsylvian trajectory with effective posterior retraction of the frontal lobe and were successful in clipping and obliterating the aneurysms. Conclusions Open clipping of unruptured intracranial aneurysms requires accuracy to preserve higher brain function. Our technique was successful in both patients, and preserving the FBVs could be useful in the treatment of such aneurysms.

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.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.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 (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.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.Особенности расположения клиновидной пазухи обусловливают возможность развития тяжелых интраоперационных осложнений при хирургическом лечении больных с хроническим сфеноидитом. Технические трудности при проведении сфеноидотомии могут возникать на начальном этапе расширения естественного соустья при его анатомической узости и невозможности заведения выкусывающих щипцов.Изучить клиническую эффективность и безопасность предложенного оригинального метода дилатационного расширения соустья клиновидной пазухи при хирургическом лечении различных форм хронического сфеноидита.В исследование включены 68 пациентов обоих полов старше 18 лет с хроническим сфеноидитом, которым показано хирургическое вмешательство на клиновидной пазухе. Пациентам 1-й группы (Применение метода дилатационного расширения соустья клиновидной пазухи посредством специальных, разработанных нами щипцов способствует сокращению продолжительности операции, улучшению интраоперационной визуализации клиновидной пазухи и результатам лечения по данным эндоскопии и контрольной компьютерной томографии. При использовании разработанного инструмента количество затрудняющих визуализацию и вызывавших необходимость коагуляции эпизодов интраоперационных кровотечений было ниже, чем при использовании альтернативной методики.Методика эндоскопической дилатации соустья основной пазухи с применением разработанного инструмента может быть использована как самостоятельно, так и в качестве предварительного этапа для расширения соустья клиновидной пазухи с последующим применением шейвера или щипцов Керрисона.

BackgroundThe choice of surgical approach for a petrous apex lesion depends on its relationship with the internal carotid artery, degree of medial expansion and pathology. The correct identification of patients who will benefit from this approach is necessary.Case reportsTwo adult patients presented with a lesion in the left petrous apex. Computed tomography showed a homogeneous mass extending anteromedially, and abutting the internal carotid artery and the sphenoid sinus in both patients. Using magnetic resonance imaging, a third recurrence of cholesterol granuloma in case one and cholesteatoma in case two were diagnosed. Both patients underwent trans-sphenoid excision, as the sphenoid sinus was well pneumatised and the lesion was medial to the internal carotid artery.ConclusionNasal endoscopic access to the petrous apex via the trans-sphenoid corridor should be preferred for benign lesions extending anteromedially in cases where lateral access is impeded by the internal carotid artery, the labyrinth and the facial nerve, and anterior trans-sphenoidal access offers a low-morbidity alternative.

Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the Otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell. Materials and methods In this study 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC, that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery. Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). Conclusion Although an SCC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Purpose Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs. Methods This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2–0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated. Results Statistically signifcant relationship was observed between the right Type 1 ON protrusion (p

Objectives: CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors. Methods: This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist). Results: There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side (p = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD (p = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB (p = 0.019). Conclusion: This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.

Small cell carcinoma (SmCC) is a type of neuroendocrine tumor commonly originating in the lung, with only about 2-4% of cases arising at extrapulmonary sites. Extrapulmonary SmCC of the head and neck has a poor prognosis and a high rate of distant metastasis. The paranasal sinus is a rare location for extrapulmonary SmCC and only a few related papers have been published to date. We report a rare case of SmCC originating from the sphenoid sinus in a patient with a recurrent pituitary tumor with a literature review.

Objective: Piriform aperture, paranasal sinuses, and the cranium dimensions were compared with each other and we investigated the alterations depending on the age and gender in these structures. Before the endoscopic sinus surgery, anatomic variations in sinusoidal region and the occurring differences should be considered. The detection of these variations plays important roles in the prevention of complications which may happen in surgery or in obtaining a successful surgical result. Materials and Methods: Piriform aperture maximum width, frontal sinuses, sphenoidal sinuses, maxillary sinuses, and craniumwidths and height length was measured from the regions that we were determined. Three hundred ninety three cases'computed tomography images were compared. The individuals without any head trauma, pathology, and surgical history in sinusoidal region were analyzed retrospectively. The detected measurements were studied among the paranasal sinuses, piriform aperture, and calvaria dimensions. Results: It was observed that the dimensions of paranasal sinuses were decreased and the dimension of piriform aperture was increased depending on age. In all individuals, a relationship in positive direction in a manner that piriform aperture width increases as the size of the cranium width increases. Morphologic alterations take place in the dimensions of paranasal sinuses as a result of bone deformations occurring in the bone structure depending age and gender in adult individuals.

The present study aimed to evaluate the morphological characteristics of the sphenoid sinus (SS), and the impact of potential influencing factors on the morphometric features using CBCT imaging. CBCT scans of 148 patients, aged between 15 and 85 (32.88 ± 15.33) years were retrospectively evaluated. DICOM files from the CBCT scans were imported into semi-automatic software and the SS of each patient was assessed for the morphological characteristics including configuration, symmetry, extension, shape, septation, volume, and maximum diameter. Furthermore, potential influencing factors such as age, gender, side, and sinus condition were analysed. A significant association was observed between sinus extension and age. Septation was also found to be significantly associated with age, gender and sinus condition. Besides, sinus volume was significantly associated with gender and sinus condition. No significant influence of shape and side on the morphometric features was noticed. The average volume and diameter of the SS were 6576.92 ± 3748.12 mm3 and 30.48 ± 9.28 mm, respectively. In conclusion, the present findings indicate that age, gender and sinus condition have a significant impact on the morphometric characteristics of the SS. Mature sinuses exhibit a post-sellar extension pattern until middle age. In addition, males, and sinuses with healthy sinus condition have larger volumes compared to females and pathological sinuses. ispartof: ANATOMICAL SCIENCE INTERNATIONAL vol:96 issue:4 pages:544-555 ispartof: location:Japan status: published

OBJECTIVES Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks. STUDY DESIGN Multi-Institutional, Retrospective Case Series. METHODS Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated. RESULTS Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months. CONCLUSION The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2224-2230, 2021.

Introduction Pituitary surgery has shifted in recent years from microscopic surgery(MS) to endoscopic endonasal surgery (EES). However, the comparative long-term outcome of these surgical approaches, including the need for subsequent re-operation has never been reported. We present our experience in a high-volume referral center experienced in both endoscopic and microscopic approaches to compare the need for re-operation after initial resection of non-functioning pituitary macroadenomas using these surgical approaches. Methods 684 patients (398 with NF adenomas) underwent trans-sphenoidal pituitary surgery in our institution between 2006 and 2017. Complete follow-up (mean 72 months, minimum two years) was available in 87 newly diagnosed patients with non-functioning pituitary macroadenomas (NFPMA; 48-microscopic and 39-endoscopic). The EES approach has been used almost exclusively since 2012. The need for repeat operation for tumor resection during the follow-up period was assessed as the primary end-point of the study. Extracted data included various demographic and clinical parameters, radiographic findings as well as the extent of resection (EOR). Results The EOR was similar for both groups, with a trend towards better EOR in the EES group. The rate of surgical complications was also similar for both groups. There was a strong trend towards lower need for re-operation in the EES group compared to the MS group (12.8% vs. 29.2%, p = 0.056). In a multivariate analysis, only EOR and Knosp grade were independently associated with the need for re-operation surgery. Conclusion Our data indicate that EES in NFPMA tends to be associated with a lower need for re-operation compared to the MS approach, with a similar rate of EOR and complications.

OBJECTIVE The utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches. METHODS Radiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated. RESULTS Of 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections. CONCLUSIONS These results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.

Background: The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population. Materials and methods: The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool. Results: The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5–4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7–3.7 cm. Conclusions: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.

Access to the lateral recess has always been a difficult task, especially in cases where the entrance to the lateral recess is very narrow. Various strategies have been described to approach it. Our study proposes a unique method of clearing debris in patients with concretions within the lateral recess. The “scrubbing brush technique” is based on easily accessible tools and has the exceptional advantage of being user friendly and having minimal potential side effects.

OBJECTIVEThe sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)–posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.METHODSThe authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.RESULTSWith the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.CONCLUSIONSThe SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.

Aimed to explore the correlation between the volume of the sphenoid sinuses (SS) and sex, age, pneumatization and its anatomical variant types.Retrospectively evaluated high-resolution computed tomography images of 170 individuals; were studied by ITK-SNAP software to measure the volume of SS.The average volume of SS was a significant difference between the gender, the volume of SS in the elderly group (≥65 years old) showed a downward trend. The volume of the SS in the variants of the anterior clinoid processes, pterygoid processes, greater wings, and clivus were significantly higher than in the nonvariants (P 0.05). With the expansion of pneumatization, the optic nerve (CNII) type 3-4, the internal carotid artery (ICA) type 2-3 and the septal insertion on the ICA have a larger volume, while the occurrence of septal insertion on only the CNII was not correlated with the volume (P 0.05).The volume of SS is closely related to age, sex, the type of pneumatization and anatomical variation. High-resolution computed tomography can facilitate a precise study of anatomical variations and adjacent structures and help ensure the safety of an operation.

Highlights • Isolated sphenoid opacification is a rare pathology that is increasingly being described and it represents 1–2% of sinus infections. • The most frequent symptom associated with isolated sphenoid sinusitis is intractable headache. • Isolated sphenoid sinusitis is usually treated surgically and endoscopic transnasal sphenoidectomy is the preferred surgical technique. • Highly inflammatory diseases such as fungal infections may be associated with an increased risk of re-ossification of the sphenoid ostium following sphenoidectomy., Introduction Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature. Methods We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis. Results 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 103% (3/29) and the mean recurrence time was 15 (9–26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25–68) for the 29 patients analyzed in our study. Conclusion Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.

Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. Transsphenoidal surgery is the first-line treatment of this adenoma. This study aimed to identify factors associated with remission outcome in patients with GH-secreting pituitary adenomas following transsphenoidal surgery.Patients with GH-secreting pituitary adenomas who underwent transsphenoidal surgery for tumor removal at Songklanagarind Hospital between January 2003 and December 2019 were retrospectively reviewed. The primary outcome was the remission of disease at the last follow-up using 2000 and 2010 consensus criteria. Using logistic regression analysis, various factors were analyzed for association with disease remission outcome.This study included 51 patients. The remission rate of GH-secreting pituitary microadenomas and macroadenomas following transsphenoidal surgery were 100% and 43.75%, respectively. Multivariate analysis showed that preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were significantly associated with nonremission outcome (P0.001 and P = 0.012, respectively). Patients with both of these factors had poor outcomes and never achieved remission after treatment, while patients with neither of these factors had high remission rates (87.5%) following surgery. Four of 6 (66.7%) patients who underwent repeat surgery gained remission.Preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were important prognostic factors that determined remission outcome after treatment. Patients who have both of these poor prognostic factors should be aggressively treated with surgery, medication, and probably radiation to optimally control the disease.

The relevance of the issues of diagnosis and treatment of isolated sphenoiditis (IS) is increasing, due to the widespread introduction into clinical practice of radiation diagnostic methods that allow the diagnosis, including latent forms of IS. Among the chronic forms of IS, polypous-cystic and fungal lesions of the sphenoid sinus (SS) predominate.To study the age, gender and radiological features of SS in patients with IS.A retrospective observational single-center non-randomized study was conducted - an analysis of the case histories of 56 patients aged 18 to 68 years who were on inpatient treatment at the Semashko Nizhny Novgorod Regional Clinical Hospital (Department of Ear, Throat and Nose Diseases of the Privolzhsky Research Medical University) in the period 2018-2020, by age, gender composition, clinical and radiological manifestations in various forms of IS.The duration of the disease was 59±19 days. Latent forms were detected in 40% of patients. Statistically, the polypous-cystic form of IS was diagnosed more often than the fungal one (z=4.2;Against the background of a significant prevalence of rhinosinusitis, the absolute values of isolated sphenoiditis, even with a relative value of 5% of the total, are very significant. Determining the phenotype of isolated sphenoiditis and their features is very important for building a consistent treatment strategy. Age, gender, clinical and radiological manifestations should form the basis of phenotyping and further construction of a therapeutic and diagnostic algorithm.Актуальность вопросов диагностики и лечения изолированного сфеноидита (ИС) все более возрастает, что обусловлено широким внедрением в клиническую практику лучевых методов диагностики, которые позволяют диагностировать в том числе латентные формы ИС. Среди хронических форм ИС преобладают полипозно-кистозные и грибковые поражения клиновидной пазухи (КП).Изучить возрастные, гендерные и рентгенологические особенности КП у пациентов с ИС.Проведено ретроспективное обсервационное одноцентровое нерандомизированное исследование — анализ историй болезни 56 пациентов в возрасте от 18 до 68 лет, находившихся на стационарном лечении в ГБУЗ НО «НОКБ им. Н.А. Семашко» (кафедра болезней уха, горла и носа ФГБОУ ВО «ПИМУ» Минздрава России) в период 2018—2020 гг., по возрастному, гендерному составу, клиническим и рентгенологическим проявлениям при различных формах ИС.Давность заболевания составила 59±19 дней. У 40% пациентов выявлены латентные формы. Статистически чаще диагностировали полипозно-кистозную форму ИС, чем грибковую (На фоне значительной распространенности риносинусита абсолютные значения изолированного сфеноидита, даже при относительной величине 5% от общего количества, весьма значительны. Определение фенотипа изолированного сфеноидита и их особенностей очень важно для построения последовательной лечебной стратегии. Возрастные, гендерные, клинико-рентгенологические проявления должны лежать в основе фенотипирования и дальнейшего построения лечебно-диагностического алгоритма.

Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p < 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel’s cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p < 0.001). All patients were treated via an endoscopic–endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG.

A 71-year-old woman presenting with headache and nausea was admitted to hospital. Magnetic resonance imaging revealed a tumorous lesion that surrounded the sella turcica and infiltrated the sphenoid sinus with bone destruction. The tumor was removed by nasal endoscopy. The histology was consistent with pituitary adenoma; immunohistochemistry indicated silent corticotroph adenoma with melanocyte proliferation. The possibility that melanocytes were incorporated into the tumor mass in the sphenoid sinus and underwent proliferation was evaluated by investigating the mechanisms of melanocyte proliferation associated with basic fibroblast growth factor (bFGF) and α melanocyte-stimulating hormone (αMSH). In the normal tissue, the pars intermedia and adrenocorticotropic hormone (ACTH)-producing cells were positive for αMSH. None of the control adenoma tissues were positive for bFGF or αMSH by immunostaining. In the present case, bFGF-positive cells and αMSHpositive cells were observed, suggesting that both may have been involved in melanocyte proliferation. The expression of bFGF has been linked to aggressive disease. Pituitary adenoma with melanocyte proliferation has not been previously reported. Careful follow-up is deemed necessary in the future.

Headache is a common symptom with etiologies that are difficult to distinguish, 1 of which is sinusitis. A solitary sphenoid lesion, which is rare, can also cause acute or chronic headaches. The authors investigated whether endoscopic sinus surgery (ESS) for solitary sphenoid lesions could reduce headache symptoms.The authors reviewed the charts of patients who underwent ESS from 2012 to 2017, whose main symptom was a chronic headache for several years. There were no remarkable pathologic findings in the nasal cavity upon endoscopic examination. Medications for reducing headaches had transient effect. Brain magnetic resonance imaging or computed tomography scans showed a solitary sphenoid lesion and the patients underwent ESS by the same otolaryngologist. In total, 16 out of 547 ESS cases that met the above conditions were included in this study. The authors evaluated the duration, character, and degree of the headaches pre- and post-operatively. The authors also determined if there was a correlation between headaches, sphenoidal lesions, and pathologic outcomes.There were significant improvements in headaches after surgery. The pre- and post-operative mean visual analog scale score for headaches was 7.27 ± 1.67 and 3.80 ± 1.82, respectively. The pathologic outcomes revealed chronic inflammation in 11 patients, nasal polyp in 1 patient, inverted papilloma in 1 patient, and fungal infections in 3 patients, but there was no clinical correlation between the headache, lesion site, and pathology.A solitary sphenoid lesion can be the cause of acute or chronic headaches. Headaches from a solitary sphenoid sinus lesion, which were not controlled by medical treatments, could be improved by surgical procedures.

OBJECTIVE: Summarize the safety and feasibility of highly selective vidian neurectomy guided by the palatovaginal canal. METHODS: Hypothermal plasma surgery was performed on 53 patients with perennial allergic rhinitis (PAR). Remove the soft tissue covering the anterior wall of the sphenoid process of palatine bone using the Coblation system. Find the palatovaginal canal and cut off the neurovascular bundle in the palatovaginal canal. Expose the anterior orifice of the vidian canal and cut off the vidian nerve. RESULTS: 53 PAR patients have conducted the novel vidian neurectomy without sphenopalatine artery trunk damage. No secondary hemorrhage and hard palate numbness happened. The symptoms of nasal obstruction, sneeze, nasal discharge, and rhinocnesmus were relieved significantly. CONCLUSION: The simple and safe approach of highly selective vidian neurectomy guided by the palatovaginal canal provides an alternative surgical option for clinicians.

Purpose This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures. Methods In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP). Results The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p Conclusion To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.

INTRODUCTION The effect of dexmedetomidine supplementation on hemodynamic stability for transsphenoidal resection of pituitary adenoma remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexmedetomidine supplementation on hemodynamic stability for transsphenoidal resection of pituitary adenoma. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2020 for randomized controlled trials assessing the effect of dexmedetomidine supplementation on transsphenoidal resection of pituitary adenoma. RESULTS Four randomized controlled trials involving 160 patients were included in the meta-analysis. Overall, compared with the control group for transsphenoidal resection of pituitary adenoma, dexmedetomidine supplementation resulted in significantly reduced mean arterial pressure at 30 minutes [mean difference (MD), -26.62; 95% confidence interval (CI), -36.71 to -16.53; P < 0.00001], heart rate at 30 minutes (MD, -16.50; 95% CI, -32.48 to -0.53; P = 0.04), blood loss (MD, -112.57; 95% CI, -165.12 to -60.01; P < 0.0001), and fentanyl (MD, -154.13; 95% CI, -303.97 to -4.29; P = 0.04), but demonstrated similar incidence of nausea and vomiting (odds ratio, 0.37; 95% CI, 0.13-1.03; P = 0.06), and hypotension (odds ratio, 2.11; 95% CI, 0.49-9.22; P = 0.32). CONCLUSIONS Dexmedetomidine supplementation was effective in improving hemodynamic stability for transsphenoidal resection of pituitary adenoma.

Background/objectives This study aims to identify radiologically the position of the optic foramen in relation to the anterior face of the sphenoid sinus, to aid surgeons in their planning for orbital decompression. Methods CT scans of 100 orbits from 50 adult patients without any abnormality were assessed. Primary outcome measures included: position and measurement of the distance from the optic foramen to the anterior face of the sphenoid sinus. Secondary outcomes included: medial orbital wall length, distance from the optic foramen and the anterior face of the sphenoid sinus to the carotid prominence in the sphenoid sinus, and the thickness of bone anterior to the optic foramen. Results The mean location of the optic foramen was just posterior to the position of the anterior face of sphenoid sinus, with an average distance of +0.4 +/- 3.5 mm. In 54% of orbits the optic foramen was positioned posterior to the anterior face of the sphenoid sinus. The finding was symmetrical in 80% of patients. Conclusions Our study identifies that the optic foramen lies posterior to the anterior face of sphenoid sinus in approximately half of cases. The position may be asymmetric in 20% of individuals.

International audience; Pneumosinus dilatans of the sphenoid sinus is a rare disorder which can be responsible for visual impairment and blindness. We present the case of an adolescent female who experienced progressive decrease in right-eye vision over 2 years. CT scan of the head showed an extensive pneumatization of the sphenoid bone extending to the lesser wing of the sphenoid and to the anterior clinoid process on the right side. MRI revealed right nerve atrophy in the optic canal and in the posterior part of the orbit. A surgical decompression of the right optic canal was performed via an intradural fronto-pterional approach. Postoperatively, her vision worsened, and at 3 years the patient was able to count fingers at 2.5 m. Our case and literature review of symptomatic sphenoidal pneumosinus dilatans confirmed that visual prognosis in such cases depended on the preoperative visual status. Early surgical decompression should be proposed whenever possible, before signs of severe visual disorders and optic atrophy.

Background: Visual complications of endoscopic sinus surgery usually occur during or immediately after the surgery. We report a case of cavernous carotid aneurysm which developed and gradually worsened after endoscopic sinus surgery was performed. Case presentation: A 63-year-old woman with chronic rhinosinusitis resistant to conservative treatment underwent endoscopic sinus surgery. Despite the surgery being successful and without complications, diplopia developed 2 weeks later. Intracranial ima- ging revealed a giant cavernous carotid aneurysm as a likely cause of the diplopia. The patient underwent endovascular stenting treatment, and the diplopia was consequently reduced. Conclusions: We experienced a rare case of cavernous carotid aneurysm which started to develop 2 weeks after endoscopic sinus surgery. Possible causes of the aneurysm in this patient are an indirect effect of surgery, such as perioperative hypertension, and bacterial sinusitis.

Hamamy syndrome (HS) is an autosomal recessive syndrome with a genetic origin that is very rarely observed. The syndrome with craniofacial dysmorphisms, including midface prominence, severe telecanthus, sparse lateral eyebrows, protruding ears, fronto-nasal abnormalities, lacrimal-salivary apparatus agenesis, thin upper vermillion border, myopia, mental retardation, sensorineural hearing impairment, congenital heart anomalies with intraventricular conduction delay, hypochromic microcytic anaemia and skeletal abnormalities of the long bones with recurrent fractures. In this paper, we report a case of two brothers diagnosed with HS at the ages of 25 and 18 years, visited out clinic at different times due to dental reasons. In the radiological examinations, it was observed that both brothers have sphenoid sinuses agenesia, and their sella turcica were smaller than normal. HS may be observed very rarely, and it should be kept in mind that, in addition to various symptoms, it may also cause sphenoid sinus agenesis and sella turcica hypoplasia as shown for the first time in this case report.

The aims of this study were to determine the sphenoid sinus volume in an Austrian population, evaluate the relationship between volume and different types of pneumatization and investigate possible age-related sphenoid sinus volume degeneration in the elderly. A total of 50 human cadaver including 25 male and 25 female samples (=100 sphenoid sinuses, age range 65-100, mean age 84.52 ± 9.50) were selected to obtain volume and anatomical variants of pneumatization by using sphenoid sinus casts, made of quadrofunctional hydrophilic addition reaction silicone. The mean sphenoid sinus volume was 4.79 ± 2.39 cm. Males showed statistically significant larger sinus volumes than females (P = 0.048). The volume differed statistically significant for the different types of pneumatization (P

Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail.

Purpose The purpose of this study was to explore the characteristic computed tomography (CT) and magnetic resonance (MR) features of small cell neuroendocrine carcinoma (SNEC) of paranasal sinuses. Materials and methods Computed tomography (n = 8) and MR (n = 14) images and clinical findings from 14 patients with SNEC of paranasal sinuses were retrospectively reviewed. Results Eight lesions were located in the ethmoidal sinus, 4 in the maxillary sinus, and 2 in the sphenoid sinus. Small cell neuroendocrine carcinoma of the sphenoid sinus showed bilateral asymmetry patterns. On CT images, bony changes were visible in all 8 cases. On MR, 4 cases contained hemorrhage, and 10 cases contained cystic or necrotic areas. All cases demonstrated marked heterogeneous enhancement, with half showing a "cribriform-like" or "geographic" appearance. The nasal cavity was the most common site invaded by SNEC of paranasal sinuses, followed by the orbits. A time-signal intensity curve examination showed a washout-type pattern in all but 1 case. The mean ± SD apparent diffusion coefficient value was 0.702 ± 0.112 (×10 mm/s). According to the Dulguerov staging system, 9 tumors were staged as N0 (1 T1, 1 T2, 5 T3, and 2 T4). The recurrence rate was 64.3%. Conclusions Some characteristics of radiological findings can provide important clues for preoperative diagnosis.

Sphenoid sinus mucocele is a rare cystic lesion. It grows gradually and causes visual disturbances, ocular motility abnormalities and headache due to cavernous sinus compression. Sudden change in sinus cavity volume by a barotrauma may compress a mucocele and precipitate symptoms that may easily be confused with decompression sickness. A diver suffering from vertigo, nausea, blurry vision and hearing loss following uneventful dives is presented in this report. He underwent hyperbaric oxygen treatment for inner ear decompression sickness but later was diagnosed as sphenoid sinus mucocele. A high index of suspicion is necessary to capture rare conditions like mucocele in the differential diagnosis for divers with symptoms suggesting vestibulocochlear origin. To our knowledge, only one sphenoid sinus mucocele case presenting as a diving injury has been previously reported.

The transsphenoidal approach is guided by a few fundamental anatomic landmarks. Pneumatization of the SS is variable, and this plays a key role in accessing the sella floor and other skull base structures. It may be absent or minimally present in both adult and, often, pediatric population, making surgical approach more difficult than usual. We aim to demonstrate that also in the more difficult cases, with a minimal level of pneumatization, the transsphenoidal approach is still possible especially with the support of neuronavigation and intraoperative magnetic resonance imaging (iMRI). We present our experience accumulated after the treatment of 6 children with minimally pneumatized sphenoid sinus describing the workflow to access the sella floor. No perioperative complications due to the surgical approach were observed, and no cases of mortality were reported. After the surgery, the visual field deficit improved in 1 patient and remained stable in three patients. No postoperative new neurologic deficits were found. No cases of cerebrospinal fluid (CSF) leak were observed. The transsphenoidal approach can be safely used even in cases of minimally or even absent pneumatization of SS as in young children. In order to have a safe approach in such patients, the use of tools, such as navigation system and iMRI, is recommended. Furthermore, the iMRI allows to avoid exposure to radiation as in case of fluoroscopy.

Sphenoid sinus accessory septations and their possible insertion on internal carotid artery (ICA) may represent a risk for endoscopic sinus surgical procedures. However, scarce data on this variant for children are available so far. This retrospective study included 220 maxillofacial CT-scans equally divided among males (13.4 ± 2.1 years) and females (13.9 ± 2.2 years). On each CT-scan, prevalence of accessory septations, number of septations in sphenoid sinuses, and their possible insertion onto ICA bone walls were recorded. Significant differences in protrusion and insertion of septations onto the ICA bone walls according to sex were assessed through Chi-square test (p .05). Possible correlations between the prevalence of accessory septations, ICA insertion, and number of accessory septations and age were assessed by means of Pearson's regression (p .05). On average, 66% of males and 71% of females had at least one accessory septation, without significant differences according to sex or age (p .05): septal insertion on ICA was found in 13% of subjects, without any significant difference for sex or age (p .05). The number of septations was significantly increased with age (p .05). The present study showed that the prevalence of accessory septations and insertion onto the ICA are independent of age and these results are similar to those reported in adults. Results will be useful for the management of endoscopic sinus surgery.

In this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC.A total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund-Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control.The AMEC group showed a significantly shorter sphenoid length (P 0.01) and lower Vidic classification score (P 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group.Our results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.