Hazan Basak

How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm

AbstractIsolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.

Endonasal Endoscopic Management of Fibrous Dysplasia Involving Sphenoid Sinus and Optic Nerve: Postoperative Outcomes

Objective: To evaluate success of endonasal endoscopic surgery in removing fibrous dysplasia (FD) lesions involving sphenoid sinuses at areas close to important structures and to assess its effectiveness in management of patient symptoms and possible complications. Methods: Retrospective analysis of all patients operated between 2007 and 2015 at our tertiary care unit with sinonasal FD effecting sphenoid sinuses. Open or combined surgeries were excluded. Clinical examination results, radiological studies, operative findings and treatment outcomes were evaluated. Results: Ten patients with optic nerve encasement in 7 (70%) were included. All had headache which completely vanished in all postoperatively. Preoperative visual changes were detected only in 5 (50%) patients from whom symptoms have resolved completely in 2 (40%) and improved in 3 (60%) after surgery. No patients had postoperative additional visual deficit. During surgery there were no major bleedings, but in 2 (20%) cases CSF leakage was inevitable, which were recognized and repaired immediately. Postoperative imaging showed total resection in 7 (70%), gross total resection in 2 (20%) patients. One patient had only optic nerve decompression due to diffuse skull disease. In a mean follow-up time of 38 months, no recurrences or growth were detected except last mentioned patient. Conclusion: For removal of FD involving sphenoid sinuses, endonasal endoscopic approach reveals a viable technique with acceptable morbidity. Decision of surgery should be made carefully by evaluating radiological evidence for possible complications and by analyzing tumor growth and symptoms of the patients. For reducing recurrences total or gross total excision should be aimed which is achievable with this approach.