PMC9282767_01
Preoperative magnetic resonance image in Case 1. (a) Gadolinium-enhanced coronal image was obtained. (b) Gadolinium-enhanced sagittal image was obtained. (c) Vista axial image was obtained. Yellow arrow indicates the thinnest part of the bone and it points to the most likely part as a suspected cerebrospinal fluid leak. (Yellow arrow) (d) Cranial computed tomography axial image showed sphenoid bony defect and fluid collection at the sphenoid sinus (Red arrow).
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F1
Magnetic resonance image (MRI) demonstrated large mass of invading pituitary fossa, sphenoid sinus, ethmoid sinus, cavernous sinus, and clivus [Figure 1].
Intraoperative endoscope image and follow-up sinus endoscopy image in Case 1. (a) After exposing sphenoid sinus, cerebrospinal fluid leak point was identified on posterior wall of sphenoid sinus and clivus. (Yellow arrow and Yellow circle) (b) After subtotal removal of the tumor, defect was packed with fat tissue, fibrin glue, and tensor fascia lata. And the cavity was entirely covered by vascularized nasoseptal flap. (c) Nasoseptal flap was stably observed on postoperative T1-weighted sagittal magnetic resonance image. (Red arrow). (d) Sinus endoscopy image was obtained after 8 months after surgery. No defect was identified.
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F2
When the anterior wall of sphenoid sinus was removed, the capsule of the tumor was observed [Figure 2].
PMC9282767_02
Preoperative magnetic resonance image in Case 2. (a) Gadolinium-enhanced coronal image was obtained. (b) Gadolinium-enhanced sagittal image was obtained. (c) Gadolinium-enhanced axial image was obtained. (d) Cranial computed tomography axial image showed bony destruction of sphenoidal bone due to brain tumor and fluid collection at the sphenoid sinus.
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F3
Sella MRI demonstrated large mass of invading middle cranial fossa, pituitary fossa, sphenoid sinus, ethmoid sinus, cavernous sinus, and clivus [Figure 3].
Intraoperative endoscope image and follow-up sinus endoscopy image in Case 2. (a) Clivus was destroyed due to tumor invasion. After exposing the right side ethmoid bone and upper tuberculum sellae, tumor was observed (b) After partial resection of the tumor, defect was packed with fat tissue, fibrin glue, and tensor fascia lata. And the cavity was entirely covered by vascularized nasoseptal flap (c) Sinus endoscopy image was obtained after 4 months after surgery. No defect was identified.
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F4
When right side ethmoid bone, upper tuberculum sellae was removed, the capsule of the tumor was observed [Figure 4].