Endoscopic Sinus Surgery, Sphenoid Sinus
Conditions
Brief summary
* Identification of the most effective approach for different lesion types * Correlation between approach and complication rates
Detailed description
The sphenoid sinus is one of the most anatomically complex and surgically challenging paranasal sinuses due to its deep location ,wide anatomical variation and proximity to critical neurovascular structures. Important structures are adjacent to the sphenoid sinus include the dura, pituitary, optic nerve, cavernous sinus, pterygoid canal and nerve, internal carotid artery, and cranial nerves III, IV, VI, V1, V2, which are vulnerable to injury with sphenoid disease. Wide anatomical variation such as Degree of Pneumatization , Septation Patterns , Sinus Size and Shape, Ostium Location ,Onodi Cells, Prominence or dehiscence of nearby structures. Therefore, surgeons must carefully select the extent of dissection to create a sphenoid opening that matches the patient's pathology while avoiding the risks associated with overly extensive openings and drilling, which may prolong healing and increase the likelihood of scarring and stenosis. Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis. Moreover, endoscopic sinus surgery is a safe and effective technique that allows a direct route to the sphenoid sinus. Because of its close vicinity to important and vulnerable structures of the skull base, delay in diagnosis and treatment can be potentially lethal. Sphenoid sinus lesions may range from mild, isolated inflammation to erosive tumors with cranial nerve deficits or cases requiring access to a pneumatized lateral recess . Additionally, conditions such as tumors, encephaloceles, mucoceles, and skull base lesions demand extra preoperative planning and careful technique selection.
Interventions
PROCEDUREendoscopic sinus surgery
Different approaches include: type I, sphenoid ostial dilation. type IIa, transnasal sphenoidotomy (sphenoidotomy without ethmoidectomy). type IIb, transethmoidal sphenoidotomy (sphenoidotomy with ethmoidectomy). type III, bilateral, common cavity sphenoidotomy, or "sphenoid drill-out;" type IV, transpterygoid approach, to expose the lateral sphenoid sinus recess. type V, sphenoid nasalization, completely removing the sphenoid sinus floor.
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients with sinonasal lesions involving sphenid sinus with or without skull base extension.
Exclusion criteria
* Severe comorbidities contraindicating surgery * malignant tumer extend beyond sphenoid sinus requiring open management
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To evaluate different endoscopic surgical approaches to the sphenoid sinus | 6 months | * Complete lesion removal measured by post operative imaging ct * Complications examples Csf leakage Optic nerve injury (measured by visual acuity) * Carotid artery injury(bleeding) * Infection(meningitis csf examination if suspected) |
| To evaluate different endoscopic surgical approaches to the sphenoid sinus regarding: * Completence of lesion removal. * Complications. - Csf leakage - Optic nerve injury | 6 month | complications rate (csf leakage , optic nerve injury, carotid artery injury) * Recurrence * Endoscopic patency of sphenoid osteum and synechia formation |
Countries
Egypt
Contacts
CONTACTDoaa Araby Mohamed, assistant lecturer
CONTACTAhmed elrahman mohamed azzam, lecturer
STUDY_DIRECTORmohamed modather, assistant professor
Assiut University
Outcome results
None listed