PMC5765243_01
Invasion of a recurrent pituitary adenoma into the skull base in a 55-year-old woman. A: Axial fluid-attenuation inversion recovery image showing extensive bilateral hyperintensities in the cerebral sulci and Sylvian fissures, suggestive of leptomeningitis. B: Axial postcontrast T1-weighted image showing an enhanced mass encasing both internal carotid arteries in the central skull base (arrow). C: Sagittal postcontrast T1-weighted image showing a multilobulated strongly enhanced mass occupying the clivus and sphenoid sinus, with intrasellar extension (arrow). D: Preoperative computed tomography (CT) scan of the skull base showing a bone-destroying mass in the clivus and sphenoid sinus, with a widening of the right sphenoid sinus ostium (arrow). E: Sagittal CT scan of the skull base showing an enhanced mass in the clivus and sphenoid sinus, with destruction of the sellar floor and intrasellar extension (arrows). F: A nasolaryngoscopic examination revealed a pulsating mass and clear discharge in the right sphenoid sinus.
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F1
Brain magnetic resonance imaging revealed a strongly enhanced mass in the clivus, while preoperative computed tomography revealed a bone-destroying enhanced mass in the central skull base (Fig. 1A-E). After antibiotic treatment for 9 days, we performed a direct endoscopic surgical repair of the skull base and resection of the pulsating mass with watery discharge in the right sphenoid sinus that had been revealed by nasolaryngoscopy (Fig. 1F).