Summary

We present the case of a rare sinonasal tumour originating in a rare location in close proximity to vital structures. We describe how the patient was managed, including detailed description of how the mass was removed.

A 54-year-old man presented with a long history of nasal blockage, recently complicated by severe headaches and a left VIth nerve palsy. CT scan showed complete opacification of the left sphenoid sinus.

Symptoms improved following administration of steroids and nasal decongestants. Histology from endoscopic debulking of the mass confirmed the presence of inverted papilloma. Fine-cut CT showed the course of the carotid artery and optic nerve, closely related to the tumour, allowing for complete removal during a second endoscopic procedure. Five years following the procedure, the patient remains symptom free.

With appropriate imaging, isolated sphenoid sinus tumours can be removed endoscopically even when in close relation to vital structures.