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Meningioma of the tuberculum sellae

CLINICAL HISTORY:
A 55-year old female patient complained one year ago of transient blurred vision in the left eye, with presence of spots before the eyes. Since that time she lost her sense of smell. She complains of progressive headaches and pressure above both eyes.

NEUROLOGICAL EXAMINATION reveals anosmia. Visual activity of the left eye is diminished to finger counting.

3 D NON-ENHANCED CT (IMAGES 1 - 2 AND 3) demonstrates a calcified multilobulated mass (arrowheads) extending from the planum sphenoidale to the suprasellar region.

MRI:
a) CORONAL T1-WEIGHTED SPIN-ECHO (600/15/1) SEQUENCE (IMAGES 4 AND 5): A suprasellar mass lesion is seen (arrowheads) with overall isointense appearance as compared to grey matter, but with evidence of a hypointense calcified component (arrow) inferiorly, protruding towards the sphenoid sinus.

b) TRANSAXIAL (IMAGES 6 AND 7), CORONAL (IMAGES 8 AND 9) AND
SAGITTAL (IMAGES 10 AND 11) GADOLINIUM-ENHANCED T1-WEIGHTED SPIN-ECHO SEQUENCES demonstrate intense and homogeneous enhancement of the tumor, except for the calcified component inferolaterally and anteriorly (arrow images 6 - 7 - 9). The tumor extends above and slightly protrudes within the sella turcica. There is slight depression of the optic chiasm (white arrow images 10 - 11) and discrete posterior displacement of the anterior third ventricle. A dural tail is identified over the planum sphenoidale (arrow images 10 - 11).

RADIOLOGICAL DIAGNOSIS is meningioma originating from the dura mater of the tuberculum sellae and the planum sphenoidale, based on the extraaxial location, the broad implantation on the dura of the planum sphenoidale and the calcification.

SURGICAL INTERVENTION confirmed the meningioma originating from the planum sphenoidale and tuberculum sellae. The center of the tumor appeared to be heavily calcified. Some tumoral strands, not recognized radiologically, surrounded the left optic nerve, probably accounting for the visual loss.

ANATOMOPATHOLOGICAL EXAMINATION (IMAGE 12) was consistent with transitional meningioma.

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Meningioma

 

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Fig. 1

Meningioma of the tuberculum sellae, Fig. 1
Meningioma of the tuberculum sellae, Fig. 2
Meningioma of the tuberculum sellae, Fig. 3
Meningioma of the tuberculum sellae, Fig. 4
Meningioma of the tuberculum sellae, Fig. 5
Meningioma of the tuberculum sellae, Fig. 6
Meningioma of the tuberculum sellae, Fig. 7
Meningioma of the tuberculum sellae, Fig. 8
Meningioma of the tuberculum sellae, Fig. 9
Meningioma of the tuberculum sellae, Fig. 10
Meningioma of the tuberculum sellae, Fig. 11
Meningioma of the tuberculum sellae, Fig. 12