Endoscopic approach to lesions of the sphenoid sinus, orbital apex, and clivus

Objective: The expanding role of endoscopic management of sinonasal disorders includes approaches to the skull base. In this report, we review our experience approaching lesions of the sphenoid sinus, orbital apex, and clivus via a transnasal endoscopic technique. Design: A retrospective, case series review of 15 patients presenting with skull base lesions approached via an endoscopic approach was performed. Emphasis was placed on analyzing the preoperative planning strategy and the surgical technique. Setting: Academic referral center. Results: We reviewed the medical records of 15 patients who underwent an endoscopic approach to the sphenoid sinus, orbital apex, or clivus. Ten patients presented with lesions of the sphenoid sinus and clivus. The lesions in this patient group included metastasis to the cavernous sinus and clivus (3); fibrous dysplasia (2); plasmacytoma of the clivus (2); and 1 patient each with cholesterol granuloma, meningoencephalocele, and recurrent teratoma. Five patients presented with lesions of the orbital apex. These included invasive fungal sinusitis (2), mucopyocele (2), and pseudotumor (1). Image-guided surgical navigation was used in each case, and all approaches consisted of entirely endoscopic transnasal techniques. Conclusions: Endoscopic approaches to the skull base are possible because of advancements in technology now available to the rhinologic surgeon. This report highlights the preoperative strategies and surgical techniques used in approaching lesions of the sphenoid sinus, orbital apex, and clivus. These extended techniques should provide a more direct, less invasive, and more cost-effective method for approaching select skull base lesions. (C) 2003 Elsevier Inc. All rights reserved.