Fig. 4.

Procedure illustrated through key surgical steps. a) A vertical mucosal incision is made between the posterior nasal septum (NS) and the rostral mucosa (RM). The septum is mobilized, followed by bilateral submucosal dissection. b) The left portion of the rostrum is drilled to access the left sphenoid sinus (SS). c) Visualization of intrasphenoidal landmarks, with the cavernous ICA displaced anteromedially. After performing a parasellar “mini craniotomy,” the dura mater is incised (d), the cyst capsule is opened, and internal decompression is achieved through progressive aspiration while alternating angled endoscopes to optimize visualization and resection. e) Endoscopic exploration of the cavity reveals areas where the capsule is densely adherent to the lateral wall of the cavernous sinus and to the third cranial nerves; therefore, complete capsule removal is not attempted. f, g) Closure is performed by filling and cranializing the left hemi-sphenoid sinus with abdominal fat, followed by suture of the rostral mucosa.