Differential diagnosis of cystic lesions in sellar region: reference values for surgical approach

Abstract

Objective To analyze and contrast the clinical features of four kinds ofcystic lesions in sellar region such as craniopharyngioma,cystic pituitary adenoma,Rathke cleft cyst and pituitary abscess,and to construct a flowchart for differential diagnosis of the four different kinds of cystic lesions.Methods The clinical data of 93 patients with histopathological evidence treated in our hospital were retrospectively reviewed.Their characteristic differences were evaluated by statistic methods.Results Young age on presentation,large volume of the lesion,compression of the third ventricleand reticular-like enhancement of the solid part were more likely to occur in craniopharyngioma.Cavernous sinus invision and homogeneous enhancement of the solid portion were more likely to occur in cystic pituitary adenoma.Rathke cleft cyst and pituitary abscess were more frequently to be seen with cystic characteristics.Short duration of preoperative symptoms,diabetes insipidus,multiple pituitary axes impaired and postcontrast enhancement of the cyst wall were more likely to occur in pituitary abscess.Conclusions The clinical characteristics and radiographic features of cystic lesions in the sellar region may mimic each other.However,part of these are specific for some diseses.A combination of the duration,ages,clinical symptoms,endocrinological and MRI features is helpful for the differential diagnosis of cystic lesions. Key words: Craniopharyngioma ;  Pituitary adenoma ;  Rathke cleft cyst ;  Pituitary abscess ;  ifferential diagnosis