PMC2929619_01
Postgadolinium coronal T1 weighted image showing an enhancing, soft tissue mass involving the right side of the sphenoid sinus and extending into the right cavernous sinus and into the suprasellar cistern.
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Magnetic resonance imaging demonstrated an extensive skull base lesion involving the sphenoid and ethmoid sinuses, pituitary fossa, and suprasellar region (Figure 1).
Coronal CT scan showing soft tissue mass in the sphenoid sinus with destruction of the roof of the sphenoid sinus.
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Computed tomography of the sinuses revealed bony destruction (Figure 2).
CT cisternogram showing a right-sided CSF leak through the roof of the sphenoid sinus.
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A CT cisternogram was undertaken to further characterise the site of CSF leakage (Figure 3).
Noncontrast CT head scan showing extensive intraventricular and subarachnoid air.
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Both attempts were unsuccessful and lumbar CSF drainage resulted in profound pneumocephalus (Figure 4).
Sagittal reconstruction cisternogram image showing contrast in the sphenoid sinus consistent with persistent CSF leak.
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Once sufficient neurological recovery had occurred, a second CT cisternogram (Figure 5) was undertaken prior to a further endoscopic endonasal repair using fat graft and fascia lata.