PMC5564091_01
The lesion appearing hyperintense on T2-weighted RMI.
CRIOT2017-7567838.001.jpg
PMC5564091_01_CRIOT2017-7567838.001.jpg
fig1
T1 and a hyperintense lesion on T2 weighted images. There was no suppressed fat on STIR sequence (Figure 1).
T1-weighted RMI in sagittal cut showing expansive cystic mass occupying the sphenoid sinus and posterior ethmoid. Observe the integrity of pituitary gland (white arrow).
CRIOT2017-7567838.002.jpg
PMC5564091_01_CRIOT2017-7567838.002.jpg
fig2
In sagittal view the pituitary gland was intact and there was no sellar invasion, excluding pituitary adenoma with sphenoidal sinus extension (Figure 2).
Removing of a solid lesion occupying the clival recess.
CRIOT2017-7567838.003.jpg
PMC5564091_01_CRIOT2017-7567838.003.jpg
fig3
It was very thick and adherent to the walls of sphenoidal mucosa, covering an osseous erosion area, especially in opticocarotid recess region (Figure 3).
Sphenoidal sinus opened and demucosalized. Suction cannula is in clival recess. Black asterisks show lateral opticocarotid recess between carotid artery (downward) and optic nerve (upward). Observe the short intercarotid distance and the absence of prominence of the sellar floor.
CRIOT2017-7567838.004.jpg
PMC5564091_01_CRIOT2017-7567838.004.jpg
fig4
The preoperative RMI shows a large intercarotid space; however, intraoperative distance between both carotid arteries was short (Figure 4).
Postoperative CT scan showing the sphenoidotomy, the posterior ethmoidectomy, and the absence of lesion.
CRIOT2017-7567838.005.jpg
PMC5564091_01_CRIOT2017-7567838.005.jpg
fig5
He presented a complete improvement of the algic picture and postoperative CT scans showed an air-filled cavity replacing the lesion in the sphenoid body with no residual soft-tissue lesion (Figure 5).