PMC10396392_01
(A) Head computed tomography image obtained 11 years prior to admission at our hospital (age 53 years) shows left thalamic hemorrhage. (B) T2-weighted magnetic resonance images in axial, sagittal, and coronal sections indicating dose planning of gamma knife surgery.
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The yellow circle indicates the 50% isodose center.
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His medical history revealed that at 53 years of age, he had a left-sided thalamic hemorrhage (Fig. 1A) and intractable pain in the left upper and lower limbs. Pituitary GKS for thalamic pain was performed with a maximum dose of 180 Gy at another hospital at 55 years of age (Fig. 1B).
Magnetic resonance images at 56 years of age show atrophy of the pituitary gland and accumulation of cerebrospinal fluid in the sella turcica. (A) T2-weighted image. (B) T1-weighted image. (C) T1-weighted image with gadolinium enhancement. The arrow indicates pituitary gland atrophy.
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Magnetic resonance imaging performed to examine the cause of the panhypopituitarism revealed remarkable atrophy of the pituitary gland (Fig. 2).
Head computed tomography images acquired on admission to our hospital (age 64 years) demonstrate fluid in the sphenoid sinus (A), a bony defect in the sellar floor (B, arrowhead), and pneumocephalus (C).
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Computed tomography of the head at the time of this visit showed pneumocephalus, fluid accumulation in the sphenoid sinus, and a partial bone defect in the floor of the sella turcica (Fig. 3).
Magnetic resonance images show no fluid in the sphenoid sinus. (A) 1 month after endoscopic surgery. (B) 23 months after endoscopic surgery.
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The patient had a good postoperative course without complications, and serial magnetic resonance images obtained 1 and 23 months after the operation revealed no accumulation of fluid in the sphenoid sinus (Fig. 4).