PMC10390265_01
CT sinus without contrast axial cut showing the air-fluid level in the sphenoid sinus and defect in the clivus (see arrow).
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fig1
Her CT skull base without contrast (Figures 1 and 2) and MRI skull base with IV contrast (Figures 3 and 4) showed clival defect with pseudomeningocele and no signs of increased ICP.
CT sinus without contrast sagittal cut showing the air-fluid level in the sphenoid sinus and defect in the clivus (see arrow).
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fig2
Her CT skull base without contrast (Figures 1 and 2) and MRI skull base with IV contrast (Figures 3 and 4) showed clival defect with pseudomeningocele and no signs of increased ICP.
MRI skull base with IV contrast axial cut showing fluid accumulation in sphenoid communicating with clival defect (see arrow).
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fig3
Her CT skull base without contrast (Figures 1 and 2) and MRI skull base with IV contrast (Figures 3 and 4) showed clival defect with pseudomeningocele and no signs of increased ICP.
MRI skull base with IV contrast sagittal cut showing fluid accumulation in sphenoid communicating with clival defect (see arrow).
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fig4
Her CT skull base without contrast (Figures 1 and 2) and MRI skull base with IV contrast (Figures 3 and 4) showed clival defect with pseudomeningocele and no signs of increased ICP.
(a)-(c): (a) Fluorescein dye coming from the defect site. (b) Bovine pericardium graft placed over the defect followed by fibrin sealant. (c) Pedicled septal flap placed over the defect.
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fig5
Intraoperatively, fluorescein confirmed the leak coming from the clivus and there was no other leak identified (Figure 5(a)). An onlay bovine pericardium graft was placed followed by a fibrin sealant (Figure 5(b)). Then, a pedicled septal flap was placed over it (Figure 5(c)).
10 months postoperative endoscopic picture showing healed skull base.
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fig6
On her 9-month follow-up visit, the patient was doing well with no evidence of recurrence (Figure 6).