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Indexed/Abstracted in: EMBASE, Scopus
Hans J. WELKOBORSKY, Julian KÜSTERMEYER, Sylvia GRASS, Anja PÄHLER, Kim V. STEINKE
Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hannover, Germany
Endoscopic approaches to the paranasal sinuses in general and to the sphenoid sinus in particular have significantly evolved over the past years. The purpose of the present review is to provide an overview of the recent developments and to review the latest literature in the field. Since clinical symptoms of sphenoid sinus diseases are often unspecific a high grade of clinical experience and appropriate imaging techniques prior to surgery are required in this group of patients. Intensive knowledge of the sphenoid sinus anatomy and adjacent structures is mandatory for endoscopic surgery. Appropriate imaging techniques are computed tomography scans in axial, coronal and sagittal planes or magnetic resonance imagingscans, which show the topographical anatomy and the relation between a pathologic process and adjacent structures. The sinus anatomy, its pneumatization and the kind and extent of sphenoid sinus disease are main crucial issues to decide the appropriate endoscopic approach. To date, indications for endoscopic surgery include isolated diseases of the sphenoid sinus (e.g. sphenoiditis), mucoceles, fungal balls, tumors of the posterior ethmoid and sphenoid, along with repair of cerebrospinal fluid leaks. Compared to microscopic operations endoscopic approaches have some advantages: 1) they are less invasive; 2) they provide a direct view on the lesion; and 3) with angled endoscopes also the lateral recess of the sphenoid sinus can be reached. These approaches can be extended cranially, medially and laterally, so that the pituitary gland, the sella and the middle and anterior cranial fossa can be reached. This led to the development of endoscopic neurosurgery. Endoscopic approaches can be divided in exclusively transnasal approaches, exclusively transethmoidal approaches, transnasal-transethmoidal approaches, transseptal approaches, and transpterygoidal approaches. For secure operation of the sphenoid sinus, identification of the sinus ostium is mandatory. Several anatomical landmarks for safely opening the sinus have been described. Recent developments in microsurgery and operative endoscopes have evolved endoscopic approaches to the sphenoid sinus. Knowing the anatomy, the procedures are safe with low complication rates and favorable outcome. However, there are only few high-ranked studies published, comparing endoscopic approaches to other surgical procedures.