Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

Abstract

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure. Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach. Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients. Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

Endonasal endoscopic surgery for temporal lobe epilepsy associated with sphenoidal encephalocele

“…Due to the recent development in endoscopy, there are increasing surgical reports of temporal encephalocele resection using the endoscopic endonasal approach. [ 2 , 5 ] However, only three cases of endoscopic endonasal surgery for epileptic temporal lobe encephaloceles have been reported as per a meeting proceeding. [ 11 ] The most likely reason for this paucity of information is that the epileptogenic mechanism could not be evaluated through this approach.…”

Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report

“…Factors contributing to CSF leak in the sphenoid sinus are congenital skull base defects, tumors, trauma, and increased intracranial pressure [14] . Lateral wall defects of the sphenoid sinus accounted for 9.8% of the normal population at autopsy [14] , [15] . Most CSF leaks close spontaneously within 7–10 days; non-closing CSF leaks increase the risk of meningitis [16] .…”

“…Most CSF leaks close spontaneously within 7–10 days; non-closing CSF leaks increase the risk of meningitis [16] . The treatment of choice for CSF leak in the lateral sphenoid sinus recess defect is transnasal endoscopic surgery that has become the standard for repairing CSF leaks with low morbidity and a highly successful rate of 90% [15] , [16] .…”

Utility of flexible interventional endoscopy in endoscopic sinus surgery: a case series

“…In the sphenoid sinuses, the lateral recesses can be accessed through a trans-pterygoid approach associated with risks of lesions to the internal maxillary artery, the sphenopalatine ganglion, and the Vidian nerve, and the infraorbital nerve (trigeminal V2). In the literature, this approach is associated with a 10% risk of xerophthalmia and nasal dryness and a 12.8% risk of lesion of the infraorbital nerve with resulting facial hypo/anesthesia [ 8 ]. Variations with partial preservation of the pterygopalatine fossa have been proposed to lower these morbidities [ 9 ].…”