Impact of Magnetic Resonance Imaging in Management of Sellar Tumors: Experience with 50 Cases

Background: Preoperative differentiation of histologic etiology of sellar lesions is of profound clinical importance because it determines the use of surgery versus nonsurgical technique, transsphenoidal versus transcranial routes and the degree of surgical resection. Objective: We provide an overview of the most relevant magnetic resonance imaging characteristics together with clinical findings of some lesions found in the sellar region in order to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of theses lesions. Methods: This prospective review with 50 patients with sellar lesion managed at the Department of Neurosurgery, Assiut University Hospital and Department of Radiology, South Upper Egypt Cancer Institute between April, 2010 to July 2012. The demographic data, clinical presentation, MRI radiographic characteristics, and the management of these patients were reviewed. Results: Among the study, 28 patients (56%) have macroadenomata; 9 patients (18%), have microadenoma; 10 patients (20%) have craniopharyngioma; 2 patients (4%) have epidermoid cyst and one patient (2%) have dermoid cyst. Collectively pituitary adenomas are common in females 59% (22/37) while craniopharyngioma are equal in both sex. Dermoid and epidemoid cyst were detected only in males. All patients with microadenoma were in the 3rd decade, while patients with macro adenoma were mostly older. In patients with craniopharyngioma there were two peaks; the first is 10 years and the 2nd is 40 years. Patients with dermoid and epidermiod cyst were older. The presenting symptoms were different according to the lesion type. Optic chiasma was stretched in all three cases of dermoid and epidermoid cyst. Optic chiasma was more likely to be stretched in all cases with craniopharyngioma except one (90%); while in patient with macroadenoma it was stretched in only 17 patients (60.7%) however; it is not stretched in all cases with micro adenoma. All cases of macroadenoma in addition to dermoid and epidermoid cyst showed a combined pattern of extension either sellar and suprasellar. All cases of micro adenoma were entirely intra sellar with no supra or para sellar extension. 2 cases (20%) with craniopharyngioma were sellar while 8 cases (80%) were sellar and supra sellar. Cystic degeneration of the tumor found in 17.5% among cases with macroadenoma and in all cases of craniopharyngioma whiles no cystic degeneration Correspondence to: Dr. Mohamed Khallaf, Email: khallaf [email protected] in cases with micro adenoma. Cavernous sinus invasion with encasement ICA was present in 60.7% (17/28) of cases with macroadenoma and in the 100% of cases with dermoid and epidermoid cyst, but not present at all in cases with microadenoma and craniophayrngioma. In 57.1% of macroadenoma (16/28), sphenoid air sinus was invaded while it was invaded in 40% (4/10) of craniopharyngioma and not affected at all in microaderoma while it was invaded in dermoid and epidermoid cyst. The treatment modalities for theses lesions were individualized according to its pathology. For pituitary microadenoma, all patients were treated conservatively by antihormonal treatment (all of them were prolactin secreting type, treated by bromocriptine). Pituitary macroadenoma were treated by surgical excision and the route of excision was either transsphenoid (11 cases) or transcranial (17 cases). All patients with craniopharyngioma underwent surgery (transsphenoid; 2 casestranscranial; 8 cases). All patients with epidermoid and dermoid cyst were excised through transcranial routes. Conclusion: MM of lesions in the sellar region is useful for the diagnosis and differential diagnosis. Precised preoperative MR imaging as well as proper interpretation of obtained results may contribute to optimize the principles of diagnostic and therapeutic procedures used in the treatment of theses lesions.