Abstract
Isolated sphenoid sinus disease (ISSD) is a rare condition that accounts for roughly 3% of all sinusitis cases. ISSD is predominantly caused by infectious and inflammation processes, with underlying fungal pathologies. This case series aims to illustrate the endonasal endoscopic management of different isolated sphenoid fungal pathologies. We described four distinct case presentations of ISSD at a tertiary hospital in Dammam, Saudi Arabia. These cases included isolated sphenoid fungal ball, allergic fungal sinusitis, and acute invasive fungal sinusitis. The management of isolated sphenoid fungal pathologies differs depending on the type of the disease necessitating early identification and adequate treatment. The endonasal endoscopic approach is successful with minimal complications and favorable outcomes.