PMC9020871_01
Preoperative magnetic resonance imaging.. a: Coronal T1-weighted image reveals a low-signal lesion in the left temporal bone of the middle cranial fossa extending from the sphenoid bone, including the left pterygoid plate (white arrow) and a left temporal encephalocele (yellow arrow).. b: Coronal T2-weighted image shows a heterogeneous high signal lesion at the same site as a (white arrow).. c: Coronal gadolinium-T1-weighted image reveals a heterogeneous enhancement lesion at the same site as a and b (white arrow).. d-f: Axial view of the T2-weighted image-driven equilibrium radiofrequency reset pulse (T2WI-DRIVE) shows cerebrospinal fluid (CSF)-like collections in the left parapharyngeal space (d: white arrow) and a CSF-like fluid in the expanded Meckel's cave extending to the petrous apex (e, f: white arrow).. g-i: Coronal view of the T2WI-DRIVE reveals a heterogeneous high signal lesion in the left temporal bone of the middle cranial fossa and the sphenoid bone, including the left pterygoid plate (g, h: white arrow) and a CSF-like fluid in the left parapharyngeal space (i: white arrow).
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Magnetic resonance imaging (MRI) (Fig. 1a-i) and computed tomography (CT) (Fig. 2a-d) showed osteolytic changes in the left temporal and sphenoid bones of the middle cranial fossa, including the left pterygoid plate.
Preoperative computed tomography (CT) and Radioisotope (RI) cisternoscintigraphy.. a-c: Axial (a), coronal (b), and sagittal (c) CT images showing osteolytic changes in the left temporal bone of the middle cranial fossa and the sphenoid bone, including the left pterygoid plate (yellow arrow).. d: Three-dimensional (3D) CT view reveals the left middle cranial base with uneven changes and skull defects (black arrow).. e: Radioisotope (RI) cisternoscintigraphy 2.5 h after RI injection suggests CSF leaks (black arrow) consistent with a T2-WI DRIVE high-intensity lesion centered in the left pterygoid plate (Fig. 2a, b), whereas no apparent CSF leak site was identified.
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On MRI, radioisotope (RI) cisternoscintigraphy 2.5 h after RI injection (Fig. 2e) suggested CSF leak associated with a T2 high-intensity lesion centered in the left pterygoid plate, whereas a CSF leak site was not identified.
Postoperative computed tomography (CT) and postoperative magnetic resonance T2-weighted imaging DRIVE.. a-c: Coronal CT view showing the drilled medial and lateral pterygoid plates extending to the left temporal bone in the middle cranial fossa (white arrow) and no pneumocephalus.. d-f: Coronal view of T2WI-DRIVE revealing disappearance of preoperative T2WI-DRIVE high signal (Fig. 1 g-i) consistent with the extent of bone removal (d, e) and a marked decrease in liquid-formed CSF leak-like high signal (f) on the preoperative T2-WI DRIVE in the left parapharyngeal space (white arrow).
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CT (Fig. 3a-c) on postoperative day (POD) 1 showed the drilled medial and lateral pterygoid plates extending to the foramen rotundum and the left temporal bone in the middle cranial fossa. MRI (Fig. 3d-f) on POD 7 revealed bone erosion removal in the middle cranial fossa.
Pathological findings.. a, b: The typical findings of affected bone are activated osteoclasts (white arrow) and thin-walled endothelium-lined capillaries of vascular or lymphatic origin (white arrowhead) (a: low-power field; b: high-power field; H&E stain).. c: CD35 immunostaining delineates the vascular endothelium (arrow).. d: D2-40 immunostaining is positive, as is the endothelium of the lymphatic channels (arrow).
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The pathological diagnosis (Fig. 4) was lymphangioma, consistent with GSD.