An Infrasellar Craniopharyngioma Involving the Sphenoid Sinus and Clivus

Craniopharyngiomas are rare, benign, epithelial neoplasms that account for about 5% of all intracranial neoplasms. Craniopharyngiomas are mainly confined to the intrasellar and suprasellar regions, with the suprasellar location being the most common. Exclusively infrasellar craniopharyngiomas with no sellar involvement are extremely rare. We reported an infrasellar craniopharyngioma involving the sphenoid sinus and clivus in a 16‑year‑old girl, and discussed the clinical features and management of this tumor. A 16‑year‑old girl presented with a 6‑month history of progressive headaches and nasal obstruction. Neurological examination revealed no cranial nerve abnormality. No signs or symptoms of pituitary dysfunction were evident. The results of laboratory studies, including hypophyseal function, were normal. R a d i o l o g i c e x a m i n a t i o n s i n c l u d e d c o m p u t e d tomography (CT) and contrast‑enhanced magnetic resonance imaging (MRI). Cranial CT showed a well‑defined infrasellar mass invading the entire sphenoidal sinus and the space just anterior to the clivus. CT scan using the bone window revealed a clear edge of the lesion. The peripheral sclerotin was compressed and thinned, but without the destruction of the clivus [Figure 1a]. MRI demonstrated a large, well‑defined, heterogeneous, infrasellar mass confined to the sphenoid sinus. The mass consisted of cystic and solid tissues with contrast enhancement of some of the solid parts after administration of gadolinium‑containing contrast medium. Contrast‑enhanced sagittal T1‑weighted images showed the sella turcica, suprasellar region, pituitary gland, brain parenchyma, cerebrospinal fluid spaces, and pituitary gland to be normal [Figure 1b‑1d]. The lesion was resected via an endoscopic endonasal transsphenoidal approach. After removal of the compressed and thinned anterior wall of the sphenoid sinus, the tumor was visualized within the sphenoid sinus. The tumor was greyish‑red, moderately vascular, and firm, with cystic areas. The tumor was removed completely in a piecemeal fashion. The entire tumor was extradural, and the sella was intact, with no extension superiorly into the sella or posteriorly through the clival dura, confirming an exclusively infrasellar location. A postoperative MRI scan confirmed complete excision of the tumor [Figure 1e‑1g]. Histologic examination revealed an adamantinomatous craniopharyngioma [Figure 1h]. The patient was discharged from hospital with improvement of her nasal obstruction and headache‑free. The patient was neurologically intact and disease‑free at 2‑year postoperatively. Craniopharyngiomas are benign but locally aggressive tumors. They are generally located intracranially and …