PMC5391488_01
Cerebral angiogram, showing a delayed posttraumatic aneurysm that involves the hypophyseal artery (arrow).
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F1
Four years later, she began experiencing severe headaches and vertigo, and a subsequent workup demonstrated a cerebral aneurysm that involved the hypophyseal artery immediately adjacent to her previous skull base fracture (Fig. 1).
Temporal bone computed tomography scan, demonstrating opacification of the left mastoid cavity with thinning of the tegmen (arrow).
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F2
A temporal bone computed tomography scan showed thinning of the tegmen on the left side (Fig. 2), and she subsequently was taken for a tympanomastoidectomy and exploration due to concern for a possible CSF leak.
(A) Sinus computed tomography scan, showing air-fluid levels in the left sphenoid and posterior ethmoid sinuses. (B) Coronal computed tomography scan, showing a possible dehiscent area that involves the left superolateral sphenoid sinus adjacent to previous endovascular aneurysm repair.
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F3
Imaging at this time showed the patient's previous aneurysm repair and fluid pooling in the sphenoid sinuses (Fig. 3).
(A) Endoscopic view, showing fracture line along the left superolateral sphenoid wall (solid arrow) with a centrally located area of dehiscence (arrow). (B) The leak site was repaired by using a nasoseptal flap.
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F4
Endoscopy revealed a left sphenoid sinus CSF leak, which was repaired with a pedicled nasoseptal flap (Fig. 4).