Isolated Sphenoid Lesions: Diagnosis and Management

Abstract

Isolated sphenoid lesions are rare. It is likely that isolated sphenoid sinus disease is underreported for a number of reasons. First, the presenting symptoms are often nonspecific; second, the inaccessibility of the sinus precludes optimal physical examination; and third, before the advent of CT and MRI scanning, radiologic examination of the sinus was inadequate. Endoscopic evaluation and current imaging techniques with CT or MRI have contributed to an increase in diagnosis of these lesions. Twenty-one patients with isolated sphenoid lesions that I treated in a 4-year period are presented. The pathology was unilateral sphenoid sinusitis (8), sphenoid mucoceles (4), inflammatory spheno-choanal polyp (3), inverting papilloma (2), invasive pituitary adenoma (1), carcinoma (1), aspergilloma (1), and fibrous dysplasia (1). Endoscopic biopsy was carried out in 7 patients (33.3%). A precise diagnosis after endoscopy, biopsy, and imaging studies was established in all patients. Definitive treatment included an endoscopic sphenoidotomy in 15 (71.4%). Five patients (23.8%) were treated with other therapeutic modalities. One patient did not require any definitive treatment. The combined use of imaging techniques and diagnostic nasal endoscopy allows for an accurate diagnosis and enables minimally invasive techniques to be tailored to the patient's disease. Isolated sphenoid pathology may be very insidious and present with nonspecific symptoms. It is therefore not surprising that these lesions have been regarded as an uncommon entity because of the lack of adequate diagnostic facilities in the past. Plain radiographs and examination with a headlight offer little diagnostic information on sphenoid pathology. The increased use of endoscopy in routine nasal examination and advances in imaging techniques of this area will probably result in more frequent diagnosis of these lesions. Twenty-one patients with isolated sphenoid lesions that I treated in a 4-year period are presented. The patient characteristics, presentation, diagnosis, and management of these lesions are described. An important feature emerging on studying these lesions was that a preoperative diagnosis, made possible by nasal endoscopy and CT/MRI scan, was invaluable in planning the treatment of these patients. Definitive endoscopic management of these lesions was possible in 15 patients.