Isolated sphenoid lesions: Diagnosis and management

Isolated sphenoid lesions are rare. It is likely that isolated sphenoid sin us disease is underreported for a number of reasons, First, the presenting symptoms are often nonspecific; second, the inaccessibility of the sinus pr ecludes optimal physical examination; and third, before the advent of CT an d MRI scanning, radiologic examination of the sinus was inadequate, Endosco pic evaluation and current imaging techniques with CT or MRI have contribut ed to an increase in diagnosis of these lesions. Twenty-one patients with i solated sphenoid lesions that I treated in a 4-year period are presented. T he pathology was unilateral sphenoid sinusitis (8), sphenoid mucoceles (4), inflammatory sphenochoanal polyp (3), inverting papilloma (2), invasive pi tuitary adenoma (1), carcinoma (1), aspergilloma (1), and fibrous dysplasia (1). Endoscopic biopsy was carried out in 7 patients (33.3%), A precise di agnosis 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 modaliti es. 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.