PMC10316206_01
(a) Coronal section contrast computed tomography (CT) scan showing a nonenhancing isointense soft-tissue mass herniating into the sphenoid sinus reaching up to the floor. (b): Sagittal section bone window CT scan showing defect size of 2.4 cm in the sellar floor with herniating soft-tissue contents.
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F1
She consulted an otolaryngologist, and on finding no significant clinical cause, a contrast-computed tomography (CT) scan was performed, which was suggestive of a well-defined corticated midline defect replacing the body of sphenoid measuring 2.4 x 1.6 cm. communicating with the nasopharynx and 3rd ventricle [Figures 1a and b], likely representing a patent craniopharyngeal canal with meningocele (type 3A).
Sagittal section T2 and T1 sequences of magnetic resonance imaging showing herniating meninges through the sellar floor into the sphenoid sinus, including anterior recess of third ventricle, with no separately identifiable pituitary gland and stalk.
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F2
These findings were corroborated on magnetic resonance imaging, with pituitary stalk and gland not being identified [Figure 2].
(a) Intraoperative microscopic view showing approximately 3 x 2 cm defect in the sellar floor with herniating meninges and pituitary stalk into the sphenoid sinus. (b) Intraoperative microscopic view showing defect (in oval) after complete reduction of contents into the cranial cavity. (c) The defect was repaired with pericranium, Surgicel, and glue (in oval).
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F3
Surgical exploration was done through a bifrontal craniotomy, with reduction of herniating meninges and pituitary stalk into cranium, excision of sac and repair of defect with pericranium, Surgicel, and glue through a subfrontal approach [Figures 3a-c].
Sagittal section postoperative computed tomography scan demonstrating replaced contents into the cranial cavity with air fluid level in the sphenoid sinus.
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F4
The postoperative CT was suggestive of complete reduction of contents into the cranial cavity with air fluid level in the sphenoid sinus [Figure 4].