Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordCerebral TumorsCystic TumorsEmbryonal TumorsLocal Extension From Regional TumorsLymphomas And Hematopoetic NeoplasmsMeningeal And Mesenchymal TumorsMetastatic TumorsNeural And Mixed Neural Glial TumorsPineal Region TumorsPseudotumoral LesionsTumors Of Neuroepithelial TissueMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.6%)
No
 
 (10.9%)
Undecided
 
 (4.5%)
You must be logged on to vote.
Please log in or register.
 
 
 

Meningioma of the sellar diaphragm

CLINICAL HISTORY:
This 55-year old woman complains of one year of decreased visual acuity. She mentions vague complaints of headaches and notes that she bumps into obstacles.

CLINICAL NEUROLOGICAL EXAMINATION shows decreased visual acuity on the right (2/10) and a left homonymous hemianopia.

CT:
a) CONTRAST-ENHANCED SCAN (IMAGES 1 AND 2): A huge intensely enhancing multilobulated mass is seen in the suprasellar region with insertion on the sella turcica.

MRI:
a) SAGITTAL T2-WEIGHTED (2000/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): A huge mass is seen in the suprasellar region. The mass is homogeneously hyperintense. Within the tumor some radial orientation of strands can be seen. The tumor is inserted on the dorsum sellae and extends along the clivus (long arrow), shows intrasellar extension and anteriorly reaches the planum sphenoidale (small arrows). There is substantial displacement of the brainstem (arrows) and elevation of the third ventricle (arrowhead).

b) CORONAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGE 4): The tumor displays an overall intensity similar to grey matter. Substantial elevation of the optic chiasm is seen (arrow) as is the compression of the lateral ventricles.

c) TRANSAXIAL (IMAGES 5 AND 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The tumor shows intense and homogeneous enhancement. The lesion is multilobulated and again some radial orientation of strands can be recognized. The tumor extends from the tuberculum sellae over the dorsum sellae to the clivus (arrows images 6 - 7). A dural tail is noted over the clivus. The tumor surrounds the right carotid artery (arrow image 5) at the level of the syphon. Note again the substantial brainstem compression.

RADIOLOGICAL DIAGNOSIS is meningioma of the sellar diaphragm based on the broad implantation on the dura of the sella turcica and the homogeneous appearance with enhancement.

SURGICAL FINDINGS: At surgery, the lesion was centered on the posterior clinoid process. The tumor showed considerable suprasellar extension, up to the superior margin of the third ventricle. The optic chiasm was displaced anteriorly. There was marked compression of the right optic nerve and the right internal carotid artery. The tumor was highly vascular and very firm. Therapy was limited to decompression of the right optic nerve and the right internal carotid artery. The rest of the tumor was inoperable due to invasion of important vascular and nervous structures.

ANATOMOPATHOLOGY: Arachnotheliomatous meningioma Grade I.

Search also:
Meningioma

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Meningioma of the sellar diaphragm, Fig. 1
Meningioma of the sellar diaphragm, Fig. 2
Meningioma of the sellar diaphragm, Fig. 3
Meningioma of the sellar diaphragm, Fig. 4
Meningioma of the sellar diaphragm, Fig. 5
Meningioma of the sellar diaphragm, Fig. 6
Meningioma of the sellar diaphragm, Fig. 7