[Operation pathways for sphenoidal sinus by nasal endoscope and treatments for correlated diseases beyond scope of sphenoidal sinus].

OBJECTIVE

We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication.

METHOD

Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion received surgical treatment.

RESULT

Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway; 1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway; 3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery, one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination, the diagnosis was established by DSA and they received interventional therapy; 4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach, and 3 cases were cured, 1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely; 2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach; 1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid, the exposed meninges were then repair surgically; 1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the lesion in sphenoidal sinus combined with antifungal therapy; 3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotherapy; 5 cases with NPC involving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examination; 5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach.

CONCLUSION

There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope. The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for lesions beyond scope of sphenoidal sinus.