Endoscopic resection of adult sphenoid sinus myofibroma: a rare case report with narrative review.

This study documents an exceptionally rare instance of primary myofibroma originating in the sphenoid sinus of a 60-year-old female patient, who presented with acute progressive diplopia, ptosis, and headache. Preoperative imaging identified a hypervascular lesion within the sphenoid sinus, accompanied by significant bone destruction. The patient underwent successful gross total resection via an endoscopic endonasal transsphenoidal approach, which enabled complete tumor excision, preservation of vital neurovascular structures, and effective skull base reconstruction. Postoperatively, the patient's neurological deficits improved significantly without complications. Histopathological and immunohistochemical evaluations, which were positive for smooth muscle actin (SMA) and Vimentin, confirmed the diagnosis. The tumor's high-risk features, such as its deep location, bone infiltration, and a 15% Ki-67 proliferation index, prompted a postoperative multidisciplinary team to consider adjuvant radiotherapy due to the increased risk of local recurrence. This case demonstrates that endoscopic resection is a safe and effective primary treatment for this rare condition and underscores the importance of individualized risk assessments and a multidisciplinary approach in managing high-risk sphenoid sinus myofibroma in adults.