Anatomy and pathology of the sphenoid sinus

Mastery over the complex sphenoid sinus anatomy and surrounding structures is essential for safe endoscopic surgical intervention. Unsafe surgery risks vision loss, ophthalmoplegia, or vascular catastrophe. Pneumatization of the sinus cavity and exposure of vital structures is variable, and should be analyzed carefully with pre-operative computed tomography imaging. Intra-operative image guidance aids in avoiding complications in the setting of high-risk anatomy or sphenoid procedures that place the anatomy at increased risk of injury. Isolated sphenoid pathology is rare, and late diagnosis with neurologic complication is common due to the non-specific symptoms of early isolated sphenoid disease. This chapter discusses the relevant anatomy of the sphenoid sinus, as well as benign and malignant pathologies that are most often encountered in the management of sphenoid sinus disease. Important characteristics of pediatric sphenoid pathology are also addressed.