OBJECTIVE: Retrospective study of the major causes of diseases that affect the isolated sphenoid sinus with discussion of the most appropriate methods of diagnosis and treatment. METHODS: A total of 45 cases of isolated sphenoid disease treated between January of 2008 and October of 2011 were evaluated by objective otolaryngologic examination and nasal-sinusal video-endoscopy, computed tomography of the paranasal sinuses and in some cases magnetic resonance imaging when necessary. In each case, was selected from the drug treatment and / or endoscopic. RESULTS: We identified 11 cases of isolated sphenoidalis (24.4%), three cases of fungal sphenoidalis (6.6%), 3 cases of polyps sphenochoanal (6.6%), 23 cases of mucoceles (51.1%) 1, meningoencephalocele (2.2%), 2 cases of CSF leak (4.4%), an inverted papillome (2.2%) and 1 case of squamous cell carcinoma (2.2%). CONCLUSION: We found a prevalence of inflammatory and infectious diseases is that the endoscopic approach to the sphenoid sinus is effective in treating various pathologies isolated sphenoid complicated or not.