Minimally invasive approaches to the sphenoid sinus

OBJECTIVE: We sought to develop an algorithm for surgical approaches to the sphenoid sinus. STUDY DESIGN AND SETTING: Retrospective review was conducted of all patients who underwent a sphenoid sinusotomy by the senior author between July 1994 and August 2001. RESULTS: The study population consisted of 141 patients, in whom 5 different surgical approaches were used: transseptal (47 (33.3%)), transnasal (19 (13.5%)), transethmoid (72 (51.1%)), transmaxillary (2 (1.42%)), and external (1 (0.7%)). Of the 47 transseptal approaches, 43 (91.5%) were for extirpation of a neoplasm. In contrast, 60 of 72 (83.3%) transethmoid procedures were for infectious/inflammatory disorders. An endoscopic approach was used for 7 of 8 (87.5%) skull base repairs. Four transsphenoid optic nerve decompressions were performed. The minor and major complication rates were 2.1% and 0.71%, respectively. CONCLUSIONS: The anatomic location of the pathologic process can guide the surgeon in selecting the most appropriate technique. SIGNIFICANCE: Surgical treatment of sphenoid pathology can be safely and successfully performed through a variety of approaches.