Meningioma - suprasellar

Case contributed by A.Prof Frank Gaillard

Presentation

Visual failure.

Patient Data

Age: 70 years
Gender: Female
CT

CT brain

There is a relatively large focal solid slightly hyperdense mass lesion in the pituitary fossa with suprasellar extension measuring approximately 27 mm in keeping with the known pituitary tumour. The sphenoid sinuses are essentially clear likewise the other paranasal sinuses and the nasal cavity. 

Appearances of the cerebral and cerebellar parenchyma are relatively unremarkable on the unenhanced scan. Slightly prominent temporal horns of the lateral ventricles identified otherwise the ventricles are age-appropriate likewise the cerebral sulcal pattern. The midline is central. No intracranial haemorrhage is shown.

X-ray

Skull x-ray

AP and lateral views of the skull are unremarkable. The pituitary fossa is normal in size. There is no evidence of bony destruction or hyperostosis. 

MRI

MRI brain

The sella and suprasellar mass lesion demonstrates homogenous and prominent contrast enhancement, measures 20 x 29 x 30.4 mm, is centred on the tuberculum sella, extends across the pituitary fossa, bulges into the prepontine cistern, interpeduncular cistern, elevates the floor of the third ventricle, and optic chiasm and nerves, and displaces the anterior cerebral arteries (which have a close contact with the superior margin of the tumour). Anteriorly extends along the planum sphenoidale, with a dural tail of enhancement. 

Differential enhancement separates the mass from the contiguous pituitary which is seen inferiorly within the sella. A tongue of tumour extends into the right optic canal. No hydrocephalus. Mild sulcal ventricular prominence within age normal range.

Annotated image

Annotated images

Normal pituitary tissue (red) can be seen separate to the mass. The infundibulum (orange) can be seen surrounded and displaced posteriorly by the mass. A dural tail (green) can be seen at the margins of the mass. The dura of the diaphragma sella is pushed down (blue), further evidence of the suprasellar origin. 

Case Discussion

This case demonstrates typical appearances of a planum sphenoidale meningioma, which should not be mistaken for a pituitary lesion. This patient went on to have this lesion resected which confirmed the diagnosis of a WHO grade I meningioma. 

Acknowledgement:

I would like to thank Mr James King, Royal Melbourne Hospital, for help with the surgical aspects of this case. 

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Case information

rID: 17615
Case created: 30th Apr 2012
Last edited: 22nd Sep 2016
Inclusion in quiz mode: Included

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