Figure 5.

A 37-year-old woman with binocular vision blurred for 3 months. (A) Artistic illustration demonstrating that the PA invades the clivus through the SS floor with sufficient pneumatization on sagittal view. (B) Preoperative sagittal T1-weighted MRI shows PA with SS and clival invasion. (C) The bone window image of CT shows that SS pneumatization is sellar type. The bony structure was destroyed to the inferior clivus by tumor invasion. (D) After resecting the SS component, the breakthrough point of the PA from the anterior sellar wall into the SS can be seen. (white dotted circle). (E) Intraoperative observation confirmed that the SS was sellar type. In addition, the tumors in the middle clivus on MRI were all in the SS. (F) After tumor resection in the sellar region, it was found that there were three breakthrough points in the sellar floor, which led to downward invasion. (G) Intraoperative observation showed that the tumor (Tu) was hidden in the honeycomb-like structure formed by the cancellous bone within the clivus. (H) The tumor was completely resected, and the bilateral ICAs were exposed in the surgical field. The dotted line indicates the location of the sellar floor.