Fig. 1
Preoperative axial computed tomography (CT) and magnetic resonance images (MRI) show left sphenoid sinus lesion.
Arrow heads indicates left sphenoid sinus in both images.
Fig. 2
These are postoperative extraocular movements of the patient.
A. Patient showed ptosis and ophthalmoplegia of his left eye in all directions after endoscopic sinus surgery.
B. 6 months after revision operation, patient's ptosis and ophthalmoplegia had been improved partially when gazing medially.
Fig. 3
Both endoscopic and histologic findings revealed fungal infection after the first surgery in another hospital.
A. Endoscopic finding of left nasal cavity shows fungal hyphae and crust around posterior ethmoid sinus and sphenoid sinus before revision surgery.
arrowhead : left sphenoid sinus, arrow : lamina papyracea
B. Histopathologic scan shows non-septated, right angled branched hyphae (H&E stain, × 400).
Fig. 4
Computed tomography (CT) and magnetic resonance images (MRI) were taken before revision surgery.
A. CT scan shows heterogenous enhancing lesion involving orbital apex (black arrow).
B. White arrow indicates occlusion of left carotid artery in MRI.
Fig. 5
These pictures are presenting brief intraoperative findings during revision surgery.
A. Most of the area between lamina papyracea and sphenoid sinus was covered with granulomatous necrotic tissues.
asterisk : middle turbinate, arrow head : sphenoid sinus, arrow : lamina papyracea
B. Magnified view of left sphenoid sinus
C. Black Circle indicates the site conducted partial optic nerve decompression.
D. Absorbable material (Surgicel®) was applied to prevent bleeding.
Fig. 6
Brain magnetic resonance images (MRI) and MR angiography were taken after revision surgery.
A. MR angiography cannot visualize left anterior cerebral artery, middle cerebral artery and ICA (white arrow).
B. Brain MRI shows infarction of left parietal lobe (white circle).