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In this paper, we aim to study the different clinical presentations of pediatric allergic fungal sinusitis (AFS) in the Eastern Province of Saudi Arabia, and to review the experience in the diagnosis & management of AFS in children at King Fahad Specialist Hospital. This study is a retrospective case series of pediatric patients diagnosed and managed as AFS at a tertiary referral hospital in Saudi Arabia. The clinical presentation of pediatric AFS varies widely and includes unilateral, unilateral with proptosis, bilateral, alternating, isolated sphenoid and extensive with intracranial & intraorbital involvements. Children with AFS present with different clinical features when compared to adults. Therefore, they require a high index of suspicion for evaluation and early aggressive treatment.

Trigeminal schwannoma is the second most common schwannoma after vestibular schwannoma. Symptoms vary depending on the anatomical structures affected by the tumor, including facial pain, paresthesia, dizziness and ataxia. The primary goals are controlling the symptoms and the maintenance of cranial nerves’ integrity perioperatively. We report a 39-year-old lady who was complaining of mild right-sided headache, vision and hearing loss, right facial weakness and dysphagia. CT and MRI showed a large dumbbell-shaped tumor originating from the trigeminal fossa abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa. An image-guided endonasal endoscopic removal was successfully done. Image-guided endonasal endoscopic removal of a trigeminal schwannoma abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa is a safe, effective approach, as it offers excellent visualization, accurate localization and safe dissection of the tumor from the critical anatomical neurovascular structures surrounding it.

Introduction Trigeminal schwannoma is a rare, benign, solitary tumor arising from the trigeminal nerve. Patients commonly present with symptoms such as facial pain and paraesthesia. Multiple approaches have been introduced to access the intracranial and infratemporal fossae. Case presentation A 39-year-old female patient complains of a mild headache on the right side, with right vision and hearing loss, right facial weakness, and dysphagia. The CT and MRI indicated a large dumbbell-shaped mass extending across the right side of the skull base, from the middle cranial fossa to the infratemporal fossa. An endoscopic endonasal approach allows a more detailed view of the midline structures by drilling the pterygoid bone and dissecting the pterygoid muscle. Conclusion The endonasal endoscopic approach is an excellent method for patients with trigeminal schwannoma in intracranial and infratemporal fossae. Familiarity with the microsurgical anatomy of the infratemporal fossa dissection techniques via anterior and lateral approaches helps provide the best results and achieve the goal of tumor removal with minimal morbidities.

Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature.