PMC5590348_01
Imaging and approach of ACMs. (a) Preoperative sagittal and (b) axial brain MRI showing the lesion. (c and d) Coronal preoperative MRI with contrast demonstrating the extension of the lesion into the left optic canal. (White arrows) show the enlargement of the left optic canal on coronal CT scan. Intraoperative endoscopic images showing; (e) post drilling of the sphenoid sinus, (f) the sellar floor, (g) dura was opened with partial resection of the tumor and dura over the pituitary gland was kept intact, (h) drilling of the optic canal, (i) tumor resection with residual tumor on the left side covering the optic nerve, (j) Resection of tumor in the optic canal on the lift side. Optic chiasm, right optic nerve and anterior communicating artery complex are observed. (k) Fascia lata, Mepore (gasket seal technique was used) and (l) Surgicel were applied. (m) Superior view of the anterior clinoid and its relation to sellar structures. (n) A superior diagrammatic illustration of the clinoidal lesion compressing the left optic nerve demonstrating; (1) the lesion, (2) the left optic nerve, (3) internal carotid artery, (4) A1 segment, (5) planum sphenoidale, (Dotted line) the falciform ligament, (Triangle) diaphragma sellae and (Star) Right anterior clinoid. (o) Coronal and (p) sagittal MRI with contrast post resection of the lesion with a small part left attached to the left optic nerve. (White arrow) demonstrates the nasoseptal flap in place
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F1
Defect reconstruction was done in a multilayer fashion with fascia lata, vomer bone, the bilateral nasoseptal flaps and a Merocel  nasal pack [Figure 1].