Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects
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.
Keywordsskull base - endoscopic transpterygoid approach - sphenoid sinus lateral recess - cerebrospinal fluid leak - meningoencephalocele
Concept - G.B., M.T.Z., P.C.; Design - G.B., M.T.Z., P.C.; Supervision - G.B., M.T.Z., H.A.E., P.C., D.L.; Resource - E.C., F.R., S.G.; Materials - E.C., F.R., S.G., J.Z., D.L.; Data Collection &/or Processing - E.C., F.R., S.G., J.Z.; Analysis &/or Interpretation - G.B., M.T.Z., H.A.E., D.L., M.B., P.C.; Literature Search - G.B., M.T.Z., M.B., J.Z., P.C.; Writing - G.B., M.T.Z., H.A.E., P.C.; Critical Reviews - G.B., M.T.Z., M.B., P.C.
All authors have read and approved the final version of the article.
GB gratefully acknowledges support from the Turkish ENT Society for support of the Research Fellowship. The authors have no other funding, financial relationships, or conflicts of interest to disclose related to this article.
Received: 19 January 2019
Accepted: 08 May 2019
21 June 2019 (online)
Georg Thieme Verlag KG
Stuttgart · New York
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