Presentation
Visual disturbances.
Patient Data
Sellar and suprasellar hyperdense mass lesion is noted measuring 3.2 x 2.8 x 2.7 cm in dimensions with coarse peripheral calcifications. It is extending to the suprasellar cistern and subfrontal region.
The mass has abroad dural base along planum sphenoidale and extends through the pituitary fossa. It shows homogenous iso-intensity on T1WI, hypointensity on T2WI, and hyperintensity on FLAIR with homogenous avid postcontrast enhancement and small anterior dural thickening. The pituitary fossa is not enlarged. It is compressing the pituitary gland downwards and compressing the optic chiasm as well as splaying the circus of Willis arteries. Differential enhancement separates the mass itself from the contiguous pituitary. There is no evidence of extension into the pituitary fossa, cavernous sinuses or orbital apex.
Case Discussion
Morphology and signal characteristics of the mass lesion arising from planum sphenoidale are consistent with a suprasellar meningioma, which was proved after surgical resection. the identification of normal pituitary gland separate from the mass excludes pituitary origin. Its mass effect upon the optic chiasm causes visual disturbances which is the most common presenting symptom. The common differential diagnosis for a sellar/suprasellar mass includes pituitary macroadenoma, meningioma, and craniopharyngioma.
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