Pneumocephalus Secondary to Fibrous Dysplasia Involving the Lateral Craniopharyngeal Canal

Fibrous dysplasia (FD) is a benign fibro-osseous lesion characterized by fibrous stroma and osseous tissue. Although typically considered a slow-growing condition with eventual stabilization, exceptional cases have been reported that challenge this notion and present clinical scenarios that require urgent treatment. A case of a patient with a history of FD who presented with acute neurological deterioration is presented. Imaging revealed a mass originating from the maxillary sinus that extended through the ethmoid cells and sphenoid sinus and subsequently into the intracranial space via the lateral craniopharyngeal canal (Sternberg’s canal), causing pneumocephalus and a shift in midline structures. The patient underwent a surgical procedure to remove the mass and reconstruction of the skull base. Caldwell–Luc approach and endoscopic nasal surgery were combined for excision, and reconstruction was performed using fascia lata and abdominal fat graft. At 6-month follow-up, the patient’s neurological symptoms had significantly improved and imaging confirmed resolution of the pneumocephalus. Craniofacial FD, a slowgrowing disease, may occasionally lead to intracranial complications. The lateral craniopharyngeal canal may facilitate the spread of the disease to the intracranial space. Surgical techniques should be tailored to individual anatomical and clinical factors. In selected cases, endoscopic repair can be performed alone or in combination with other techniques.