PMC9610367_01
Axial computed tomography scan, bone window with osteomyelitis extension within the occipital bone base and the sphenoidal sinus.
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F1
Bone window revealed demineralization with trabecular pattern, and cortical involvement of the walls of the ethmoid and sphenoid sinuses, pterygoid processes, turbinate bones, nasal septum, clivus, petrous apex, vomer, carotid foramina, greater wings of the sphenoid bone, frontal processes, orbital processes of frontal bone, and anterior and posterior clinoid processes, [Figure 1].
Axial magnetic resonance imaging demonstrating a hypointense lesion with sphenoid boy and clival bone involvement (a) infiltrating nasopharyngeal submucous tissue (b) with a hypointense appearance in T1 and T2 sequences. Gadolinium enhancement in T1 of sphenoid and clival bone tissue.
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F2
Magnetic resonance imaging (MRI) of the skull base at the level of the clivus and the petrous apex showed soft tissues as isointense to muscle tissue in T1-weighted sequence and hyperintense in T2-weighted as well as in fluid-attenuated inversion recovery sequence, with gadolinium enhancement in fat-saturated contrast-enhanced T1-weighted (T1+C+FAT) sequence, [Figure 2].
Axial diffusion-weighted imaging with focal fluid along the anterior wall of the sphenoid sinus persisting hyperintensity, suggesting focal abscess.
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F3
Loss of fat planes among soft tissue was identified with restriction in diffusion sequence, corroborated in apparent diffusion coefficient (ADC) sequence map, [Figure 3].
Navigation-guided transnasal transclival endoscopic extended approach with clival drilling.
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F4
Given the MRI findings, surgical excision through navigation-guided transnasal transclival endoscopic extended approach and later nasoseptal pediculated flap rotation was performed, [Figure 4].
Microphotography of histopathological bone tissue sample with hematoxylin and eosin staining. Numerous angled hyphae of Aspergillus spp. are identified (yellow arrow).
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F5
Aspergillosis, [Figure 5]. A culture confirmation of the fungus was realized, with positive results to Aspergillus spp.