PMC8645465_01
Brain magnetic resonance imaging before initial endoscopic transsphenoidal surgery. Coronal (a) and sagittal (b) sections of T1-weighted images and sagittal T2-weighted image (c) show a multilobular lesion compressing the optic chiasma upwards. No sphenoiditis can be detected.
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F1
An intrasellar, multilobular, and cystic lesion extending to the suprasellar region was detected by brain magnetic resonance imaging (MRI) [Figure 1].
Brain magnetic resonance imaging, 4 years after the initial operation (a and b) and just before the second surgery (c and d). Coronal (a and c) and sagittal (b and d) sections of T1-weighted images. Thickened sphenoid sinus mucosa well enhanced by gadolinium is seen (arrow).
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F2
Brain MRI showed a thickened sphenoid sinus mucosa, well-enhanced on T1-weighted images [Figure 2].
Intraoperative endoscopic views during the second surgery. A fungus ball (arrow) is seen forming around the polyvinylidene fluoride suture used for dural closure.
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F3
In the second operation, while the sphenoid sinus mucosa was intact, the end of a dural suture was focused to be the focus of the fungal ball [Figure 3].
Histologic photomicrographs of fungal ball specimen. Staining with both hematoxylin and eosin (a) and Grocott's methenamine silver (b) shows Y-shaped fungal hyphae consistent with Aspergillus. The scale bar indicates 20 microm.
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F4
Postoperatively, she was treated with oral voriconazole 400 mg daily for 3 months because pathological examination of the fungal ball confirmed the presence of Aspergillus hyphae [Figure 4].