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Images in Neurology |

Sphenoid Sinus Fungus Ball With Skull Base Erosion

Gary L. Gallia, MD, PhD; Masari Ishii, MD, PhD
Arch Neurol. 2010;67(12):1528-1529. doi:10.1001/archneurol.2010.296.
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An 85-year-old woman with a history of polymyalgia rheumatica was evaluated for recurrent sinusitis at Johns Hopkins Hospital, Baltimore, Maryland. She had a several-year history of headaches secondary to sinus disease that responded well to medical therapy. The patient had undergone computed tomography of the head 4 years previously that demonstrated opacification and expansion of the left sphenoid sinus (Figure 1A). Over time, her symptoms increased in frequency and were less responsive to medical therapy. Because of her worsening symptoms, she again underwent computed tomography, which demonstrated opacification of the left sphenoid sinus, with high-density central contents and expansion of the walls. Compared with her previous computed tomographic scans, there was now significant erosion of the skull base (Figure 1B). Magnetic resonance imaging demonstrated an expansile lesion in the left sphenoid sinus that was centrally T1-weighted hyperintense and T2-weighted hypointense and isointense without significant enhancement (Figure 1C and D).

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Figure 1.

Preoperative head computed tomography (A and B) and brain magnetic resonance imaging (C and D). A, Head computed tomography (bone window) performed 4 years previously demonstrates a sphenoid sinus mass with intact bone over the skull base. B, Recent head computed tomography (bone window) demonstrates erosive changes in the skull base over the sella and left carotid artery (arrows). Axial (C) and sagittal (D) magnetic resonance images following gadolinium administration demonstrate an expansive lesion in the sphenoid sinus.

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Figure 2.

Intraoperative endoscopic view following removal of the sphenoid sinus fungus ball. The neurovascular structures at the skull base are clearly visualized through the semitransparent mucosa and dura, including the pituitary gland (PG), left carotid artery (CA), left optic nerve (ON), left cavernous sinus (CS), and anterior intercavernous sinus (AIS).

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