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The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.

Rathke's cleft cysts (RCCs) typically present as intrasellar lesions, with exclusive sphenoid sinus involvement being exceptionally rare. We report the seventh documented case of an intrasphenoidal RCC in a 39-year-old male presenting with blurred vision and headaches. Complete resection was achieved via an endoscopic endonasal approach, and the patient remained symptom-free on follow-up. To our knowledge, this is the first report to provide a series of endoscopic images illustrating the appearance and resection technique. We review the literature on this rare entity and summarize current investigative and management paradigms.

Objective The most common surgical technique for the management of pituitary adenomas is the endoscopic endonasal transsphenoidal approach (EEA). preoperative neuroimaging along with detecting surgical landmarks of the sphenoid sinus during surgery is important for making a successful operation. Method This study includes 1009 patients with pituitary adenomas who underwent EEA between 2013 and 2020. We evaluated the anatomical features of the sphenoid sinus through a panel of items obtained from imaging and intra-operative findings. Results Our result includes 57.38% nonfunctional, 8.42% cushing, 12.39% prolactinoma, and 21.8% acromegaly patients who had undergone endoscopic endonasal transsphenoidal surgery. The mean age of the patients was 45 with a male to female ratio of 1.2:1. Sellar sphenoid type was the most common (91.8%) with only 12% symmetrical inter sphenoid septa, Internal carotid artery dehiscence was found in 1.7% of the cases. Apoplexy was present in 6.3% of patients, which was found more prevalent in nonfunctional adenomas (9.67%, Odds ratio: 4.85, 95% CI 2.24–11.79) and further investigation revealed a significant association between apoplexy and sphenoid mucosal edema and hemorrhage (Odds ratio: 43.0, 95% CI 22.50–84.26), and between apoplexy and cystic lesions (OR = 4.14, 95% CI 1.87–8.45, P -value < 0.0001). Acromegaly is associated with the increased number of lateral recces (Odds ratio: 11.41, 95% CI 7.54–17.52), septation of the sphenoid sinus (Marginal mean: 3.92, 95% CI 3.69–4.14), edematous sinonasal mucosa (Odds ratio: 6.7; 95% CI 4.46–10.08), and higher bony (OR: 4.81, 95% CI 2.60–8.97, P -value < 0.001) and cavernous (OR: 1.7, 95% CI 1.13–2.46, P -value < 0.01) invasion. Conclusion The present study provides anatomical data about the sphenoid sinus and its adjacent vital structures with adenomal specific changes that are necessary to prevent complications during endoscopic advanced transsphenoidal surgery.

Human identification in complex cases, such as charred skeletal remains and advanced decomposition, requires reliable methods to associate the identity of a missing person with an unidentified body. Among the different types of human identification, radiological methods are effective as they generally allow qualitative and quantitative analysis of anatomical, pathological, and therapeutic peculiarities, whose combination of information forms a unique set of characteristics that can lead to a positive identification. In this context, the present study aims to evaluate the distinctiveness of the sphenoid sinuses, and to classify and identify their morphological patterns in the studied population, with potential application for human identification. This retrospective observational study analyzed 91 cone beam computed tomography (CBCT) scans of Brazilian individuals (34 males; 57 females) over the age of 25 years. A qualitative analysis was performed focusing on the sphenoid sinuses' morphological pattern, as well as their presence, number, and position in sagittal and axial CBCT slices. The sphenoid sinuses were present in 100 % of cases, 48.3 % had one septum, 30.7 % had two septa, and 20.8 % had three intersphenoidal septa. Septa type 3 (in the midline) were the most common (42.9 %; n = 39), while type 4 (slightly left to the midline) were the least frequent (3.3 %; n = 3). In the sagittal section analysis, post-sellar type (IVa) septa were the most frequent (50.5 %; n = 46), while the pre-sellar type septa were the least frequent (14.3 %; n = 13). The turbinate pattern (type I) was not detected in this study. From an anatomical point of view, great morphological and dimensional variability were found between the sinuses. It was possible to observe qualitative and quantitative morphological differences that allow the individualization of the sphenoid sinus, which can support human identification. •Sphenoid sinus was present in 100 % of CBCT scans analyzed.•Great morphological variability supports forensic identification.•Most common axial septum position: type 3 (midline insertion).•Post-sellar (IVa) type was most frequent in sagittal sections.•CBCT is a reliable tool for identifying anatomical uniqueness.

Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.

PurposeTo measure the volume of the sphenoid and ethmoid sinuses and to analyse the asymmetry index values by age/gender.MethodsThree-dimensional (3D) Computed Tomography (CT) images of 150 individuals (75 females, 75 males) of both sexes between the ages of 18–75 were included in our study. Sphenoid and ethmoid sinus volumes were measured using the 3D Slicer software package on these images, and the asymmetry index was calculated.ResultsIn our study, mean sphenoid sinus volume (female right: 4264.4 mm3, left: 3787.1 mm3; male right: 5201.1 mm3, left: 4818.2 mm3) and ethmoid sinus volume (female right: 3365.1 mm3, left: 3321.2 mm3; male right: 3440.9 mm3, left: 3459.5 mm3) were measured in males and females. Left sphenoid sinus values of males were statistically higher than females (p = 0.036). No statistically significant relationship existed between age, sinus volumes, and asymmetry index (p > 0.05). A statistically weak positive correlation existed between males’ left sphenoid and ethmoid sinus volume (rho = 0.288; p = 0.012). There was no statistical relationship between asymmetry index in the whole group (p > 0.05). A statistically weak negative correlation was found between sphenoid and ethmoid sinus asymmetry index in males (rho=-0.352; p = 0.002). There was no statistical relationship between asymmetry index in females (p > 0.05).ConclusionKnowing paranasal sinus morphology, morphometry, and asymmetry index value will be significant for preoperative and postoperative periods.

Background The standard endoscopic endonasal approach gives access to the median sphenoid sinus, but not to its lateral part. We propose an endoscopic technique for lesions in the lateral sphenoid sinus. Method Based on our experience with 28 patients, we have developed a less invasive approach to the lateral recess of the sphenoid sinus, limiting the opening of the maxillary sinus while avoiding resection of the inferior turbinate and ethmoidal cells. The technique is described. Conclusion The proposed endoscopic approach is reliable and safe to treat CSF leak or tumours located within the lateral recess of the sphenoid sinus.

Background The sphenoid sinus (SS) is important in neurosurgical practice because it is surrounded by numerous critical neurovascular structures. Using helical computerized tomography (CT) scanning, we investigated the gender-related volumetric asymmetric nature of the SS. Materials and methods CT scans of SS of 49 (21 females, 28 males) patients admitted to the hospital between 1 October 2018 and 1 June 2019 were analyzed retrospectively. The volumes of SSs were calculated using a secondary reconstruction tool. Results The mean age was 33,81 for females, 41,107 and in males patients which was not statistically significant. The mean right and left SS volume was 3,03 cm 3 and 3,.57cm 3 in females, but 4,28cm 3 and 4,70cm 3 in males, respectively. The difference in side asymmetry between men and women was statistically significant ( p  < 0.05). Conclusion In this study, the gender-related side differences of the SS have been the first time reported in this study. The reason for this gender-related asymmetric size of the SSs may be related to the pneumatization process.

Background The sphenoid sinus features many anatomical variations between individuals from different populations in the world. The understanding of these variations is important for the surgeons to plan for surgeries which involve intervention through the nasal approach. The aim of the present systematic review was to perform a qualitative synthesis of available studies which assess the effect of sphenoid sinus (SS) anatomical variations on the outcomes of endoscopic endonasal transsphenoidal surgeries (ETSS). Methods The current review followed PRISMA 2020 guidelines. A systematic advanced electronic search was performed in four databases Medline (via PubMed), Scopus, Web of Science (WoS) and Lilacs in December 2023. Studies that assessed the anatomical variations of the SS that affect the outcomes of ETSS were eligible for inclusion. A qualitative synthesis of the methodology and results of the included studies was carried out. Quality assessment was performed using the National Institute of Health (NIH) quality assessment tool (last accessed on December 24, 2023). Results A total of 14 studies were included in the qualitative synthesis. Most of the studies included in the review found that the sellar pneumatization was the commonest followed by the postsellar type. Single intersphenoid sinus septum (ISS) was found to be the most common variation, which is more frequently found in males compared to females. There was sex difference seen in the attachment of the ISS to the carotid canal. It is more commonly attached to the posterolateral wall of the sinus in males compared to the females. Though complicated cases were less compared to uncomplicated ones, cerebrospinal fluid (CSF) leak was the leading post operative complication amongst the complicated cases and paranasal sinus (PNS) computed tomography (CT) scan showed ISS findings differed from intraoperative findings. Conclusion It is concluded that the ISS poses the commonest anatomical variations encountered during the ETSS. During planning for transsphenoidal endoscopic procedure, the ISS should thoroughly be assessed to minimize potential surgical complications.

PurposeSphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications.Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures.MethodsA literature search of PubMed and Embase (Elsevier) databases was performed using the keywords “sphenoid sinus” and “anatomy, “sphenoid sinus” and “anatomic variants”, “sphenoid sinus”, and “anatomic variations”.ResultsWe described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septationsConclusionThe information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.