Isolated sphenoid sinus disease (ISSD) is where there is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. Although computer tomography (CT)-based 3D reconstruction remains the gold standard among noninvasive approaches to ISSD diagnostics, no standardized techniques for direct intraoperative measurements of the sphenoid sinus volume in ISSD patients have been documented. We suggest a novel technique for the intraoperative measurement of the sphenoid sinus volume. Our technique is based on filling the sinus with 0.01% methylene blue solution after an endoscopic endonasal sphenoidotomy. The proposed technique was applied to 40 ISSD patients during surgery. Obtained intraoperative measurements were compared to noninvasive measurements from 3D reconstructions based on preoperative CT scans. Our results demonstrated that the obtained measurements did not exhibit significant differences exceeding 0.4 cm³, with CT-scan-based measurements in 39 out of 40 cases (p < 10⁻⁶, Wilcoxon sign-rank nonparametric test), thus confirming the accuracy of the proposed technique. Disagreements between direct intraoperative and CT-based measurements in a single case have been attributed to the presence of remaining pathological masses in the sinus, which was further confirmed during the secondary check of the operated sinus. Accordingly, we suggest that the agreement between the CT-based and intraoperative volume measurements can be used as an indicator of the successful elimination of all pathological masses from the sinus without having to perform an adequate exposure of the entire sphenoid sinus to reduce intraoperative bleeding. The proposed technique is accurate and does not require the involvement of specialized intraoperative CT scanners and avoids additional radiation exposure for the patient during an additional postoperation CT scan to confirm the success of the surgery.

Isolated sphenoid sinusitis (ISS) is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. The gold standard for analyzing and diagnosing ISS is computer tomography. Many researchers have discussed the treatment of patients with ISS variants such as fully opacified sinus, mostly with surgery. A retrospective analysis of clinical data of 59 patients (21 male (35%), 38 female (65%)) with ISS, who were treated in the Otorhinolaryngological Department of Pavlov First Saint Petersburg State Medical University between January 2017 and January 2020, was conducted. All patients were in the first stage of the same medical therapy. In cases where there was no recovery, these patients were referred to surgery. For the control group, we analyzed patients without any disorders according to CT-scan examination. After analyzing the obtained clinical and radiological data, we found indicators that were common in patients who did not recover after medical therapy. According to the reverse regression method statistical model, in male patients with a diffuse headache and nasal discharge it was shown that medical therapy was highly effective (more than 78%). The presence of nasal septum deviation and adenoids in male and female patients leads to the highest risk of surgical treatment (83% probability of the logistic model). The detailed analysis of CT-scans and the complaints of patients with ISS can be the key to determining the preferred therapy choice. Not all cases need to have an endoscopic opening of the sphenoid sinus, according to our research.

A rare case of oncocytic Schneiderian papilloma originating from the sphenoid sinus characterised, for 3 years, by non-specific symptoms of severe headache, a block of nasal breathing, and deprecating sense of smell was presented by an elderly female patient. Sphenoid sinus functional endoscopic sinus surgery (FESS), with a one-block tumour excision, through an endonasal approach, with a histological study of removed tumour masses, were performed on the patient. Long observation in the post-operative period was necessary, considering the risk of recurrence and malignancy of oncocytic Schneiderian papilloma (OSP). Although the oncocytic papilloma of the sphenoid sinus is rare, non-specific symptoms make this pathology easily misdiagnosed. Thus, any isolated unilateral process in the paranasal sinuses with long-existing symptoms must be given careful attention due to the chance of this process being an inverted papilloma with malignization. CT scan indicating a unilateral opacification of paranasal sinuses with local calcifications is a typical manifestation, and endoscopic sphenoidotomy can be recommended as a treatment of choice.

Introduction. Spontaneous nasal liquorrhea is a pathological condition associated with defect between nasal cavity and intracranial structures that lead to the expiration of the CSF from the nasal cavity.The objective is to evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment.Material and methods. For the period from 2008 to 2018, 38 patients with spontaneous nasal liquorrhea were examined and treated in Pavlov First Saint Petersburg State Medical University, the clinic of neurosurgery of Kirov Medical Institute and Almazov National Medical Research Centre. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal aproach.Results. Only in 4 cases, there was a large defect, the failure of the closure of which required repeated surgical intervention in 1–2 weeks after the initial operation.Conclusion. The use of autologous tissues (muscle or fat autograft) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in a large size defect (more than 5 mm).

Mucocele is a benign, cyst-like lesion of the paranasal sinuses that develops as a result of persistent obstruction of drainage through the sinus ostium. The frontal sinus and ethmoid cells are most commonly affected. Isolated involvement of the ethmoid cells, particularly its posterior part, is relatively rare and often asymptomatic. Prolonged blockage of the ostium leads to secretion stasis and increased pressure on the bony walls. This results in thinning and expansion of the bone, with cavity formation. Currently, the main treatment approach is endoscopic sinusotomy with opening and drainage of the mucocele, followed by ostium enlargement. Surgical access to this area is technically difficult. Opening the posterior ethmoidal cells often requires dissection of the anterior group. However, in cases of isolated lesions, the necessity and advisability of disrupting intact surrounding structures, which common in the traditional transethmoidal approach, remain debatable. In such cases, computer-assisted navigation is used as an auxiliary technology to facilitate the surgeon’s orientation within the surgical field. This article presents a clinical case of surgical treatment of an isolated mucocele of a posterior ethmoidal cell, performed under local anesthesia with the use of navigation equipment. The lesion was drained through a direct approach, positioned medial to the middle turbinate, analogous to the access route used for the sphenoidal recess.

INTRODUCTION. Isolated sphenoid sinus disease is a rare condition due to the topographic location of the sinus. In complicated cases and the occurrence of a chronic course, the main method of treatment is surgical cure. There are different approaches to the main sinus, the most effective and safest is endoscopic endonasal sphenotomy. However, in cases of anomalies or disorders of the development of the sphenoid sinuses, as well as the need for combined operations, the transeptal approach may be the method of choice.OBJECTIVE is to evaluate the effectiveness and security of the proposed access.METHODS AND MATERIALS. A prospective analysis was carried out of 52 patients who underwent surgical treatment of isolated sphenoiditis at the Clinic of Otorhinolaryngology of the Pavlov State Medical University in the period from 2018 to 2023.RESULTS. In 5 cases, the sphenoid sinus was opened by transseptal approach. As a result of the analysis of the two approaches, no statistically significant differences were found.CONCLUSIONS. Our surgical interventions with transseptal approach in patients with minor sphenoid sinuses, impaired course of the internal cerebral artery, as well as the need for simultaneous correction of the nasal septum revealed the advisability and effectiveness of approach in such situations, as well as its safety in relation to neurovascular structures.