PMC5122815_01
Pre- and postoperative clinical course. 0: Onset day, mos: Months, ETSS: Endoscopic transsphenoidal surgery
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F1
A 53-year-old woman presented with severe left retro-orbital pain and diplopia for 1 month [Figure 1].
Serial magnetic resonance imaging (MRIs) in the pre- and postoperative course. (a) An initial MRI demonstrating enlargement of the left cavernous sinus (CS). (b) Enlargement of the right CS after two sessions of methylprednisolone (mPSL) pulse therapy. (c) Sphenoid sinus mucosal thickening after additional mPSL pulse therapy. (d) Further swelling of the bilateral CSs at 1 month after mPSL pulse therapy, unclear border between the CS and the pituitary gland, and the sphenoid sinusitis worsened. Cystic change is also seen in the pituitary gland. (e) The CS and the pituitary lesion decreased in size. (f) No recurrence of the CS or the pituitary lesions
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F2
A magnetic resonance image (MRI) revealed an enlargement of the bilateral CS, in which the left side was dominant [Figure 2a]. An MRI showed noticeable enlargement of the right CS [Figure 2b]. MRI revealed multiple low-intensity lesions in the pituitary gland and the bilateral CS. Mucosal thickening and fluid collection in the sphenoid sinus were also seen [Figure 2c]. Hypertrophic dura mater around the sellae was also observed, and the sphenoid sinusitis had worsened [Figure 2d]. Clarithromycin and carbocisteine were continued for 3 months after the operation, at which time, decreased swelling of the bilateral CSs and no effusion in the sphenoid sinus were noted on the follow-up MRI [Figure 2e]. An MRI revealed the decreased size of the CS and pituitary lesions [Figure 2f].
Serial magnetic resonance angiography (MRA) in the pre- and postoperative course. (a) No internal carotid artery (ICA) aneurysms revealed in the bilateral cavernous sinus (CSs) on the initial MRA. (b) A 2-mm de novo aneurysm arising from the right C4 portion of the ICA. (c) A 3-mm aneurysm with slight enlargement. White arrow: Aneurysm
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F3
A tiny aneurysm was discovered to have arisen from the C4 portion of the right ICA as revealed by MR angiography (MRA) [Figure 3b]. This aneurysm was not apparent on the initial MRA [Figure 3a]. However, the intracavernous aneurysm remained without change as revealed by MRA [Figure 3c].