Surgical Intervention for Asymptomatic Isolated Sphenoid Sinus Opacification: A Systematic Review

Background: Isolated sphenoid sinus opacification (ISSO) involves pathology limited to the sphenoid sinuses, deep within the skull behind the nasal cavity. Although often asymptomatic, ISSO can cause severe complications such as vision loss or intracranial infection. Its clinical relevance has grown due to advances in imaging, enabling more frequent detection. Aims/Objective: This systematic review evaluated whether surgical intervention is necessary for asymptomatic ISSO to improve patient outcomes and guide clinical practice. Methods: A comprehensive search of Web of Science, PubMed, and CINAHL through July 23, 2024, identified English-language studies on the management of asymptomatic ISSO. Studies focusing solely on radiologic findings or symptomatic patients were excluded from the study. Thirteen quantitative studies were included, with sample sizes ranging from 1 to 9 patients. Data were extracted per PRISMA guidelines, focusing on study design, patient demographics, diagnostics, and outcomes. Results: All patients underwent surgery, with 92% treated endoscopically. Surgical outcomes were generally favorable, with minimal complications. However, few studies offered clear justification for surgery in asymptomatic cases, and diagnostic criteria and follow-up protocols varied. Conclusions and Significance: Surgical treatment may be warranted in select asymptomatic ISSO cases to prevent serious complications. Further research comparing surgical and nonsurgical management is needed to establish evidence-based guidelines.