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The sphenoid sinus and related anatomy should be known considering the intimate relationships with vital surrounding structures, such as the internal carotid artery, the optic canal, the maxillary and the vidian nerves. The sphenoid sinus has numerous variations regarding the pneumatization, the septation and the relation with the neurovascular structures. Multiplanar sinus CT scan is mandatory in the preoperative evaluation of the patient to avoid injury during endoscopic sphenoidotomy.

In this article, we review and describe the importance of the anatomical landmarks of the sphenoid sinus on the CT scan, the anatomic findings that augment the risk of complications during sphenoid sinus endoscopic surgery. Moreover, we discuss about the appropriate type of endoscopic approach of the sphenoid sinus depending on the localization of the pathologic process and the experience of the surgeon, as well as the endoscopic surgery challenges. We analysed 100 patients who addressed to our clinic in the last 6 months and who underwent CT of the paranasal sinuses and we studied the pneumatization type and the anatomic variations of the optic nerve and the internal carotid artery.

A variety of sphenoid sinus anatomy variations were found, and we emphasize the value of imagining evaluation before performing functional endoscopic sinus surgery.