The Sphenoid Sinus

Abstract

■ The sphenoid sinus, known in the past as the “neglected sinus” [30], has attracted growing attention over the past 10 years due to the development of diagnostic techniques, the innovation of selective endonasal endoscopic approaches to the sinus itself and to the latest advancement in surgery, which foresees using the sphenoid sinus as the gateway to the sellar area and to the middle and posterior skull base.

■ Improved diagnostic techniques. The routine use of nasal endoscopy, computed tomography scans and magnetic resonance imaging has increased the number of diagnoses of sphenoid disease [4, 7, 9, 10, 16, 19, 28]. Early diagnosis is fundamental because the presenting symptoms are both poor and non-specific, and often diagnosis is made after the arousal of a complication, due for instance to bone erosion involving the surrounding structures [9]. The possible complications can be very serious; in fact, the sphenoid sinus is strictly related to important and vulnerable structures such as the pituitary gland, the optic nerves, the cavernous sinuses, the internal carotid arteries, and cranial nerves III, IV, V and VI [16].

■ Improved surgical techniques. The classic approach to this region was aggressive and disfiguring. The development of intranasal endoscopic techniques offers a practical alternative to the traditional methods; the endoscopic approach allows direct access to the sphenoid sinus while preserving other nearby anatomical structures and, furthermore, being an easier and quicker surgical manoeuvre it is able to prevent the complications that may arise with the sphenoid disease [7, 9, 10, 17–19, 22].

■ Surgical access to the skull base. Endoscopic surgery on the middle and posterior skull base is becoming increasingly refined and the sphenoid sinus is the chief anatomical structure for the various approaches to the skull base [5, 6, 10, 11, 13, 14, 21, 22, 27].