Intrasellar Meningioma Research Articles

Intrasellar psammomatous meningioma: a case report and review of the literature

Intrasellar meningioma (IM) is a rare occurrence that is difficult to distinguish preoperatively from the most common non-functioning pituitary adenoma. Here we describe a case of psammomatous IM occurring in a 68-year-old woman, presented with visual defects. On magnetic resonance imaging (MRI) she was found to have an intrasellar mass with suprasellar extension that was approached with transsphenoidal surgery. Subtle radiological hints, namely dural tail sign, intralesional calcifications and a marked and homogenous early enhancement of IM on MRI after gadolinium administration, may aid clinicians in achieving an accurate pre-operative diagnosis and choosing the proper surgical approach. The clinical and neuroradiological features of IM described in the literature has been reviewed.

Pure Intrasellar Meningioma Mimicking Pituitary Adenoma: A Novel Neuroradiologic Finding

Pure intrasellar meningioma is an extremely rare tumor that is difficult to diagnose as it resembles a pituitary adenoma in its clinical, endocrinologic, and radiologic presentation; it can only be distinguished through histopathologic examination. All previously reported cases of this lesion were considered those of pituitary adenoma at the initial diagnosis. This poses major challenges in clinical diagnosis. We report a case of a pure intrasellar meningioma in a 27-year-old man. A boundary between the tumor and pituitary gland may be evident on magnetic resonance imaging, thus enhancing the diagnosis of pure intrasellar meningioma.

Hypopituitarism caused by an intrasellar meningioma: case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Malignant intrasellar meningioma presenting as an invasive pituitary macroadenoma: A rare case report and literature review.

Intrasellar meningiomas are rare tumors that have the ability to mimic non-functioning pituitary adenomas. The majority of meningiomas are slow-growing and benign, therefore an intrasellar meningioma with malignant histological features is extremely rare. The present study describes the case of a malignant diaphragm meningioma that was controlled through combined chemotherapy, following subtotal surgical resection. The patient's symptoms ceased and no tumor recurrence was detected at the 3-year follow-up. Hormone levels were also observed as normal. Further investigation of similar cases may aid in achieving an accurate pre-operative diagnosis. This would prove particularly beneficial in regards to intrasellar meningiomas due to their specific location and surgical treatment. The present study analyzes the requirement of chemotherapy for the treatment of these unique tumors.

Pure Intrasellar Meningioma Located Under the Pituitary Gland: Case Report

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.

Sellar meningiomas: an endocrinologic perspective

To review the clinical manifestations and outcomes of those with sellar meningiomas treated surgically at Mayo Clinic between 1975 and 2003. This is a retrospective chart and pathology review of 17 patients with a diagnosis of purely or largely intrasellar meningiomas treated surgically at our institution. Data in regards to presentation, endocrine hormonal status, surgical approach, pathology findings, outcome and adjunctive treatment were abstracted from the medical records. The majority of patients present with visual disturbances. All 17 tumors were WHO grade I. Surgical cure was achieved in 53% after initial surgery. Postsurgical hypopituitarism occurred with high frequency. A substantial proportion of patients required subsequent surgical intervention or adjunctive treatment with external beam radiation. Sellar meningiomas are technically challenging and carry a high risk for visual disturbance and pituitary hormonal abnormalities. Many patients experience persistent disease requiring further intervention. These patients require long-term follow-up for evaluation of recurrence or development of new pituitary hormonal insufficiencies.

An Intrasellar Meningioma Masquerading as Pituitary Apoplexy

Intrasellar meningiomas are uncommon tumours, and rarely present with acute symptoms. We describe a 63-year-old woman with an intrasellar mass that presented with sudden headache and severe loss of vision. Magnetic resonance imaging (MRI) was consistent with the clinical diagnosis of pituitary apoplexy, but trans-sphenoidal surgery and biopsy unexpectedly revealed an intrasellar meningioma, and excision could not be completed. A subsequent craniotomy was performed in order to remove the remainder of the tumour. Pre-operative differentiation of an intrasellar meningioma from a pituitary macroadenoma is important as it determines the method of surgical excision, but the two lesions may be indistinguishable even with modern neuro-imaging techniques.

Prognostic factors of postoperative visual outcomes in tuberculum sellae meningioma

Tuberculum sellae meningiomas usually present optic pathway related symptoms, such as decreased visual acuity and/or visual field defect. In this report, the authors retrospectively analysed 27 patients with tuberculum sellae meningioma who underwent surgical treatment and then sought to identify prognostic factors of the postoperative visual outcomes. From April 1998 to June 2006, the authors treated 27 patients diagnosed with tuberculum sellae meningioma. Age, gender, duration of symptoms, tumour size, tumour consistency on intraoperative and T2WI findings, and resectability were analysed as potential prognostic factors of postoperative visual outcomes. Pre- and postoperative ophthalmological examinations were performed in all patients. Of the 27 patients who presented with visual dysfunction before operation, 12 were improved (44.4%), nine were unchanged (33.3%) and six worsened (22.2%). Those patients with a symptom duration of less than 1 year had a greater likelihood of visual improvement than those with a symptom duration of more than 1 year and those with a soft tumour had a greater likelihood of visual improvement than those with a hard tumour, though this was without statistical significance. Moreover, patients with high signal intensity lesion on T2-weighted images had a greater likelihood of visual improvement than those with an iso or low signal intensity with statistical significance. An excellent correlation was found between tumour consistency and appearance on T2-weighted images (p = 0.001). The results of this study indicate that MRI-T2WI can be used to estimate tumour hardness preoperatively and that this is an important prognostic factor of the visual impairments caused by intrasellar meningioma.

Transnasal endoscopic surgery of the sellar region: study of the first 100 cases

An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas); 21 null cell adenomas (3 microadenomas and 18 macroadenomas); 19 Cushing disease (11 microadenomas and 8 macroadenomas), 10 prolactinomas (6 microadenomas and 4 macroadenomas), and 4 LH adenomas (4 macroadenomas). In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function, and reduction of hospitalization times and coasts. The main limits have been the reduction of field depth, constant need of manual control of the endoscope, and required experience of the endoscope technique.

Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients.

We reviewed the clinical features, essential laboratory data, pituitary imaging findings (computerized tomography and magnetic resonance imaging), management, and outcome of 353 consecutive patients with the presumptive diagnosis of pituitary tumor investigated from January 1984 through December 1997 at University Hospital, Lausanne, Switzerland. In 18 cases primary empty sella turcica was diagnosed, and in 13 cases of pseudacromegaly there were no endocrine abnormalities. The remaining 322 patients disclosed abnormal pituitary masses, including 275 pituitary adenomas, 18 craniopharyngiomas, 6 cases of primary pituitary hyperplasia, 6 intrasellar meningiomas, 6 cases of distant metastases, 4 intrasellar cysts, 2 chordomas, 1 primary lymphoma, and 1 astrocytoma. Biologic data and immunohistochemical analysis of the excised tissues demonstrated that prolactinomas and nonsecreting adenomas (NSAs) were the most frequent pituitary tumors (40% and 39%, respectively), followed by somatotropic adenomas with acromegaly (11%) and Cushing disease (6%). In contrast with the vast majority of NSAs, which significantly expressed glycoprotein hormones in tissue without secreting them, there was a small group of glycoprotein hormone-secreting adenomas (2%), which had a more severe clinical course after surgery. Thirty-eight pituitary masses were incidentally discovered, most of them NSAs. The expansion of pituitary adenomas into the right cavernous sinus was twice as frequent as to the left cavernous sinus. For the differential diagnosis of hyperprolactinemia, basal prolactin (PRL) levels above 85 micrograms/L, in the absence of renal failure and PRL-enhancing drugs, and a PRL increment of less than 30% after thyrotropin-releasing hormone (TRH) accurately ruled out functional hyperprolactinemia due to NSA, and were typical of prolactinomas. For screening and follow-up of acromegaly, basal growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, as well as the paradoxical GH response to TRH (present in 2/3 acromegalic patients), could be used as convenient tools, but the most accurate test for diagnosis and prediction of outcome after therapy was GH (lack of) suppression during oral glucose tolerance test. In Cushing disease, single evening plasma cortisol was as good as the overnight dexamethasone suppression test for screening, and a combined dexamethasoneovine corticotropin-releasing hormone (oCRH) test was as accurate as the long dexamethasone suppression test to confirm the diagnosis. Bilateral inferior petrosal sinus catheterization coupled with oCRH test confirmed the pituitary origin of excess adrenocorticotropic hormone (ACTH) in all patients, including those with normal pituitary on magnetic resonance imaging (50% of the cases). However, this procedure failed to predict tumor localization correctly within the pituitary in 21% of patients. Pituitary cysts, meningiomas, and craniopharyngiomas with an intrasellar component were correctly diagnosed based on pituitary imaging in 75%, 67%, and 44% of cases, respectively. The remainder, as well as the cases of pituitary hyperplasia, metastases, and other less frequent pathologies, were initially diagnosed as NSAs or as masses of unknown nature. When surgery was indicated, pituitary adenomas and other intrasellar masses were operated on by the transsphenoidal route, with the exception of 100% of meningiomas, 83% of craniopharyngiomas, and 10% of NSAs, which were operated on by the transcranial route. Favorable late surgical outcome of prolactinomas could be predicted by a restored PRL response to TRH. However, dopamine agonist (DA) therapy, usually resulting in satisfactory control of PRL levels and in tumor shrinkage, progressively displaced surgery as primary treatment for prolactinomas throughout the study period. After full-term pregnancy, the size of prolactinoma decreased in 7 of 9 patients, and PRL was normal in 2. Surgery was the first treatment for NSAs, with a tumor rela

Intrasellar meningioma mimicking pituitary apoplexy: Case report

BACKGROUND A purely intrasellar meningioma is extremely rare. All the intrasellar meningiomas reviewed in the literature presented with symptoms of hypopituitarism and/or visual disturbance. A case of intrasellar meningioma with a sudden onset of headache and diplopia, mimicking a pituitary apoplexy, is reported. CLINICAL PRESENTATION This 35-year-old man with a sudden onset of headache and double vision was admitted. Neuroimages suggested an intrasellar tumor. Although a pituitary adenoma was suspected from clinical symptoms, a meningioma was compatible with neuroradiologic findings. INTERVENTION Transsphenoidal and frontoorbito-zygomatic approaches were attempted for removal of the tumor. Pituitary apoplexy could not be proved at either operation. The histopathologic diagnosis of this tumor was a fibrous meningioma. CONCLUSION The meningeal tail sign on magnetic resonance images may be a key to diagnosing intrasellar meningiomas.

Intrasellar meningioma: case report and review of the literature

Intrasellar meningioma is a rare clinical entity, and surgical resection may be difficult when it is hypervascularized. A case of subdiaphragmatic hypervascular intrasellar meningioma with attachment to the dura of the anterior wall of the sella turcica is described. Literature review of 18 cases with operatively confirmed intrasellar meningioma discloses unexpected intraoperative bleeding and relatively low resectability of the tumor are also described. We used preoperative endovascular embolization of feeding arteries, and resected a hypervascular intrasellar meningioma by a combined transsphenoidal-transcranial approach safely and without massive bleeding. Preoperative endovascular embolization of feeding arteries and combined transsphenoidal-transcranial approach are useful for the surgical resection of hypervascular intrasellar meningiomas.

Intrasellar meningioma

Two purely subdiaphragmatic intrasellar meningiomas are described. The rarity of this unusual intrasellar tumor is stressed, and the differential diagnosis of intrasellar meningioma versus pituitary adenoma is discussed. The good results of the rhinoseptal route for surgery are emphasized.

Roentgen Therapy for Pituitary Adenoma

There is general agreement that pituitary adenomata are frequently responsive to radiotherapy. Since the publications by Gramegna (1) and Béclère (2) in 1909 numerous articles have appeared concerning the favorable action of roentgen rays on pituitary adenomata of all three types. A review of this literature shows that there is a wide variation in the method of giving roentgen therapy. The more commonly employed technics have involved the use of multiple courses of comparatively small doses given at long intervals. The reports have also shown considerable variation in the incidence of successful results. Our own material includes cases which have been treated with roentgen rays by a large variety of technics, and with wide range of total estimated dose delivered to the pituitary. Because of this variation in methods of treatment, it was felt that an analysis of the results with respect to the therapeutic technic and total dosage might yield data suggesting an optimal procedure. The material available for analysis includes 64 cases of pituitary adenomata. Of these, 38 were chromophobic, 21 eosinophilic, and 5 basophilic. The clinical syndromes of these three types of adenomata have been repeatedly described in numerous publications and will therefore not be discussed here. In all cases the diagnoses were established prior to treatment by groups of competent internists, neurologists, ophthalmologists, and radiologists. There were occasional instances, as also reported by others, where different tumors so closely simulated the syndrome of chromophobic adenoma that they were mistakenly treated as such. Only after failure of roentgen therapy, at surgical intervention or postmortem examination, was the true character of the process established. Thus, we had one case of intrasellar meningioma, one case of paraphysial cyst of the third ventricle, and two cases of Rathke pouch cysts without calcification. These 4 patients have been excluded from the series. Such cases of mistaken diagnosis occur in only a very small percentage of the patients with a clinical diagnosis of pituitary adenomata. The proportion is so small that the errors do not significantly alter the improvement rates following radiotherapy. Confirmation of the diagnosis of pituitary adenomata was obtained in 16 of our cases either by surgery or at postmortem examination. Radiotherapy was the primary method of treatment in 61 of the 64 cases. In 13 of these 61 patients, surgery was later performed. Three cases were first treated surgically and were given radiation therapy for postoperative recurrence. The technics employed in treating this series of cases varied mainly in the total dosage delivered, the number of courses given, the treatment period for each series (in days) and the over-all time for the multiple courses (months to years). The physical factors of irradiation were comparatively uniform. They were: 180 to 200 kv.; 0.5 mm. Cu and 1 mm. Al to Thoraeus filtration; h.v.1. 0.9 to 2.0 mm. Cu; target-skin distance 50 to 60 cm. Usually three pituitary fields were employed: frontal and right and left temporal. The field sizes varied from a circle 5.0 cm. in diameter to a rectangle 6 × 8 cm. Occasionally parafrontal, superior, and mastoid fields were employed.