PMC4476136_01
A CT scan of the axial images reveals (a) multiple intracranial air bubbles and pneumatization of the dorsum sellae, (b) fluid accumulation in the sphenoid sinus, and (c) bony defects at the clivus (arrows). (d) Reconstructed three-dimensional CT image clearly demonstrates multiple bony erosive defects at the clivus
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Tokyo, Japan). Three-dimensional images with surface rendered and multiplanar reformatted (MPR) images were reconstructed on the workstation. The axial CT scan images revealed multiple intracranial air bubbles with pneumatization of the dorsum sellae [Figure 1a], fluid collection in the sphenoid sinus [Figure 1b], and bone defects at the clivus [Figure 1c]. The bone CT reconstruction clearly showed multiple bone defects on the upper and middle third of the clivus [Figure 1d].
Sagittal reconstruction of MPR images obtained by high-resolution CT with intrathecal injection of contrast medium. (a) Thirty minutes after injection, contrast medium advances into the interpeduncular and prepontine cistern, but not into the sphenoid sinus. (b) One hour after injection, contrast medium is clearly shown entering into the sphenoid sinus through the bone defects at the clivus
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MPR images confirmed the passage of contrast medium through the bone defects at the clivus into the sphenoid sinus 1 h after injection of the contrast medium [Figure 2]. Moreover, these MPR images revealed pneumatization of the dorsum sellae.
Intraoperative endoscopic views. (a) CSF leakage through the multiple bone defects at the clivus (arrows) was confirmed clearly. (b) Pedicled nasoseptal mucosal flap (arrow) overlayed along the clivus with fibrin glue soaked sheet of polyglycolic acid (Neoveil)
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The fistulas were successfully repaired in a multilayered fashion with fibrin glue, absorbable polyglycolic acid felt (Neoveil, Gunze, Japan), autologous fat, and fascia grafts from the abdomen followed by a pedicled nasoseptal mucosal flap [Figure 3].
CT scan reveals (a) no intracranial air, and (b) no fluid accumulation in the sphenoid sinus during the follow-up period
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In addition, recurrence of CSF accumulation in the sphenoid sinus or intracranial air on CT scan was not found for 5 years after discharge [Figure 4].