title: Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience.
abstract: OBJECTIVE
  To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions.
  
  
  METHODS
  Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted.
  
  
  RESULTS
  A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively.
  
  
  CONCLUSIONS
  Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery,Tanta University Hospitals,Egypt.
authors.forename: A S
authors.initials: AS
authors.lastname: Elhamshary
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery,Tanta University Hospitals,Egypt.
authors.forename: H E
authors.initials: HE
authors.lastname: Romeh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery,Tanta University Hospitals,Egypt.
authors.forename: M F
authors.initials: MF
authors.lastname: Abdel-Aziz
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery,Tanta University Hospitals,Egypt.
authors.forename: S M
authors.initials: SM
authors.lastname: Ragab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult