PMC4338496_01
Preoperative Postcontrast CT Scans of the Head. Axial and coronal CT scans were used to assess margins of the sellar mass. (a, b) The tumor extended into the sphenoid sinuses and eroded through the clivus and medial aspect of the cavernous sinus on right side (b)
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F1
Computed tomography (CT) with contrast revealed a 4.9 x 3.2 cm sellar mass with extension through the sphenoid sinus and posterior ethmoid air cells, compression of the optic chiasm and right optic nerve, and bony destruction of the clivus [Figures 1 and 2].
3-D images of the skull base tumor generated from the patient's preoperative CT (a, b)
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F2
Computed tomography (CT) with contrast revealed a 4.9 x 3.2 cm sellar mass with extension through the sphenoid sinus and posterior ethmoid air cells, compression of the optic chiasm and right optic nerve, and bony destruction of the clivus [Figures 1 and 2].
Median maxillotomy was performed with preservation of anterior nasal spine (a). Each segment of hemi-maxillae was retracted inferiorly and laterally with stabilization of the clivus (b)
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F3
A standard LFO was performed with midline maxillotomy to separate the maxilla between the incisors [Figure 3a]. The separated maxillae were rotated and retracted laterally [Figure 3b].
Stereotactic neuronavigation was used intraoperatively to ensure adequacy of exposure before beginning microdissection (a-c). Anterior surface of tumor was exposed followed by coagulation of tumor capsule (d)
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F4
Following exposure of the sella turcica and inferior clivus, microdissection and stereotactic navigation was used to dissect the tumor off the medial walls of the cavernous sinuses bilaterally, optic chiasm and optic nerves superiorly, and the dura behind the clivus [Figures 4 and 5].
Microdissection of the tumor continued in a piecemeal fashion (a-c)
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F5
Following exposure of the sella turcica and inferior clivus, microdissection and stereotactic navigation was used to dissect the tumor off the medial walls of the cavernous sinuses bilaterally, optic chiasm and optic nerves superiorly, and the dura behind the clivus [Figures 4 and 5].
Prior to completion, stereotactic neuronavigation was used to check the margins of the gross total resection including inferior margin (a), superior margin (b), and posterior margin (c). The medial aspect of the right carotid was inspected for sufficient decompression and decompression of the optic nerve (d)
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F6
Surgifoam followed by Gelfoam was placed in the posterior margin of the resection [Figure 6]. Subsequently, an abdominal fat graft was placed in the resection cavity.
Maxilla continuity was restored (a). Postoperative panorex orthopantogram demonstrated healing of the maxilla segment (b)
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F7
The maxilla segments were reconstructed with preregistered plates and soft palate was reapproximated in layers [Figure 7].
Postoperative Postcontrast CT Scans of the Head. CT images show fat graft in the center of resection cavity along with surrounding surgifoam and postoperative products (a, b). CT confirms midline fat graft placement during surgery (c)
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F8
Postoperative imaging was obtained [Figure 8].
The histopathology revealed the tumor was composed of mononuclear and giant cells. The giant cells were uniformly distributed throughout the tumor (H and E, x400)
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F9
Fields testing. Histological examination revealed tumor morphologically identical to the previous biopsy [Figure 9]. Focal reactive bone formation was noted.