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. 2025 Aug;15(8):828-836.
doi: 10.1002/alr.23572. Epub 2025 Mar 24.

A Novel International Endoscopic Sphenoid Surgery Classification (IESSC): A Delphi Consensus

Hussain Albaharna  1 , Abdulaziz Alrasheed  2 , Abdulaziz AlQahtani  3   4 , Alkis J Psaltis  5 , Amin Javer  6 , Cem Meco  7   8   9 , Christos Georgalas  10 , Eric W Wang  11 , Isam Alobid  12 , Kazuhiro Omura  13 , Luis Fernando Macias-Valle  14 , Marc Tewfik  15 , Narayanan Prepageran  16 , Paolo Battaglia  17 , Paolo Castelnuovo  17 , Ricardo Carrau  18 , Richard Douglas  19 , Richard Harvey  20 , Roy R Casiano  21 , Shahzada Ahmed  22 , Saad Alsaleh  2   23
Affiliations

A Novel International Endoscopic Sphenoid Surgery Classification (IESSC): A Delphi Consensus

Hussain Albaharna et al. Int Forum Allergy Rhinol. 2025 Aug.

Abstract

Background: Advancements in endoscopic sinus and skull base surgery created a need for standardized terminology to describe sphenoid sinus surgery. Although classification systems exist for other sinuses, one for endoscopic sphenoid sinus surgery is lacking. Developing such a system would standardize procedure descriptions and promote a common language among surgeons. This study aimed to develop a new classification system for endoscopic sphenoid surgery.

Methods: Consensus on a novel endoscopic sphenoid surgery classification system by running the Delphi procedure with 16 rhinology experts from around the world.

Results: Four Delphi rounds were required to reach a consensus on all stages of the classification. The average percentage of agreement on the stages of classification progressively increased from 70.83% in the first round to 87.68% in the last round. The rejection rates continuously decreased from 8.81% in the first round to 4.44% in the last round. The classification system was developed as follows: stage 1, presphenoid surgery; stage 2A, partial sphenoidotomy; stage 2B, complete sphenoidotomy; stage 2C, transpterygoid sphenoidotomy; stage 3A, Rostral sphenoidectomy; and stage 3B, extended sphenoid drill-out.

Conclusions: This novel endoscopic sphenoid surgery classification system facilitates the description of different sphenoid sinus procedures, providing surgeons with better opportunities for discussion and communication.

Keywords: classification; consensus; endoscopes; paranasal sinus diseases; rhinosinusitis; skull base; sphenoid sinus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram showing the process of reaching consensus.
FIGURE 2
FIGURE 2
Average percentage of agreement and disagreement plotted against the Delphi rounds.
FIGURE 3
FIGURE 3
Illustration showing the stages of the final endoscopic sinus surgery classification system. ASW, anterior sphenoid wall; CR, clival recess; ET, eustachian tube; IT, inferior turbinate; LR, lateral recess of sphenoid sinus; MT, middle turbinate; MS, maxillary sinus; NP, nasopharynx; NS, nasal septum; SO, sphenoid ostium; SS, sphenoid sinus; SB, skull base.
See this image and copyright information in PMC

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