PMC7265470_01
(a) Coronal and (b) sagittal view of preoperative gadolinium enhanced T1-weighted magnetic resonance image revealing homogeneous enhancing tumor compressing the left optic nerve. (c) Postoperative coronal contrast enhanced computed tomography showing removal of the tumor.
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F1
Magnetic resonance imaging revealed a 19 mm suprasellar and sellar mass lesion with contrast enhancement [Figure 1].
(a) Intrasurgical view at the first reoperation showing partial necrosis (black arrows) of the nasoseptal flap (NSF) (white arrowheads) and cerebrospinal fluid (CSF) leakage from the above. (b) Schematic drawing of Figure 2a which clearly shows the NSF, flap necrosis, and CSF leak point (asterisk).
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F2
During surgery, careful removal of the packing around the planum sphenoidale and sella tunica revealed that the superior half of the NSF was partially necrotic and shifted posteriorly [Figure 2].
Intrasurgical view at the second reoperation revealing (a) partial necrosis of the nasoseptal flap and fat pieces that were prevented from engrafting; the area within the dashed line represents the area planned for debridement; (b) after debridement of the necrotic region, the area within the dashed line represents the actual debrided region; (c) multi-reconstruction of the dural defect done with the fascia, non-necrotic flap, and fat pieces.
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F3
We again performed emergent EES [Figure 3].