PMC3565560_01
Sagittal, axial, and coronal magnetic resonance images showing a large giant cell tumor originating from the clivus and involving both cavernous sinuses.
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The ICAs were lateralized and upward dislocated, the dural layer was respected, and the brainstem was not compressed (Figure 1).
Endoscopic intraoperative images showing the erosion of the sphenoid bone by the tumor (A), the drilling of the apparently healthy bone near the carotid region (B), and the microcottonoid adhering to the artery fissuration (C).
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Local control of the bleeding was challenging, but it was obtained by using topic hemostatic agents and leaving microcottonoids adhering to the artery fissuration (Figure 2).
(A) Internal carotid artery angiography demonstrating the pseudoaneurysm originating near the inferior meningohypophyseal trunk and the microcottonoid adhering to the internal carotid artery fissuration (white asterisk). (B) Exclusion of the pseudoaneurysm after the endovascular treatment.
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The intraoperative tearing of the ICA led us to perform an immediate postoperative angiography, disclosing a pseudoaneurysm originating near the inferior meningohypophyseal trunk, which was successfully treated by embolization with coils (Figure 3).
Brain magnetic resonance imaging performed 6 years after surgery, demonstrating the absence of tumor relapse and no foreign body granuloma formation.
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