Primary neoplasms of the sinonasal region, including the sphenoid sinus are relatively uncommon and include a wide range of pathologies including sinonasal undifferentiated carcinoma (SNUC), squamous cell carcinoma, giant cell tumors, neuroendocrine tumors and mucoepidermoid carcinomas as seen in our Recent Article on this topic. These tumors tend to be locally invasive and can extend into the nasal cavity and orbits as well as the skull base to involve the cavernous sinus, sella, clivus and cribiform plate areas; some large aggressive tumors also have intradural extension impinging upon the brain and/or cranial nerves.
Sinus carcinomas typically cause epistaxis (nasal bleeding), facial pain, cavernous sinus symptoms (double vision or facial numbness) and headache. Tumors that grow into the sellar/pituitary region may cause symptoms of Pituitary Failure (Hypopituitarism).
These tumors are typically diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) of the brain and paranasal sinuses.
The aggressive nature of most sinonasal carcinomas typically warrants multimodality treatment including surgical resection and radiotherapy, as well as chemotherapy in some cases. The exact treatment regimen is highly dependent upon the exact pathology. Given advances in endoscopy, instrumentation and anatomical understanding, many if not most sinus carcinomas are now removed or debulked via an Endonasal Endoscopic Approach, including those with intradural and/or orbital extension.