Gadolinium sella

Collision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-year-old man who underwent tumor resection 36 and 18 years prior to presentation for bladder and colon cancer, respectively, without recurrence presented with bitemporal hemianopsia, ptosis, and diplopia of the right eye...

Intracranial xanthogranulomas (XGs) have been found at various sites, but xanthogranuloma of the sellar region is extremely rare. We report about a case of sellar XG in a 34-year-old female. Magnetic resonance imaging showed a solid-cystic mass located at the sella turcica. The cystic component was hyperintense on the T1-weighted image (WI) and T2WI. The solid component was hyperintense on T1WI and hypointense on T2WI. There was peripheral enhancement after gadolinium administration. The diagnosis of cystic macroadenoma was considered before surgery...

BACKGROUND AND PURPOSE: The use of gadolinium-based contrast agents contributes to the cost of MR imaging and prolongs image-acquisition time. There are also recent concerns regarding gadolinium deposition, particularly in patients who require frequent follow-up MRIs. The purpose of this study was to assess whether gadolinium-based contrast agents are needed during MR imaging follow-up for unoperated pituitary macroadenoma. MATERIALS AND METHODS: A total of 105 patients with unoperated pituitary macroadenoma who underwent follow-up MR imaging of the sella were included in this retrospective study...

OBJECTIVE: We report a case of pituitary metastasis (PM) presenting with acute anterior and posterior pituitary dysfunction following a two-decade-long oncologic course marked by disease progression. CASE REPORT: An elderly woman with a history of stage IIA invasive ductal carcinoma of the breast presented with confusion. Her laboratory evaluation was significant for panhypopituitarism and central diabetes insipidus, and magnetic resonance imaging findings were suggestive of PM...

Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas, and aneurysms. High-quality imaging is fundamental for diagnosis, characterization, and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing...

PURPOSE: Measurement of the pituitary stalk (PS) diameter does not always solve the issue of minimal PS thickening. A previously undescribed image is found at the infundibular level on high resolution thin section T2W MRI in a large number of normal individuals. We speculate that this image-whose exact origin is still unknown-may serve as a marker of the normal infundibulum. METHODS: In the last 6 months, 350 consecutive adult patients suspected of sellar pathology or controlled after medical or surgical treatment prospectively underwent a pituitary MRI including a sagittal T2W high resolution sequence...

Background and Introduction: The success of endoscopic skull base surgery is largely based on the effective repair of the skull base defect. A pedicled nasoseptal flap (NSF), described by Hadad-Bassagateguy is the workhorse of contemporary endoscopic skull base repair. We describe a modification in the technique, "double breasting technique," using the bilateral posterior NSF for skull base repair. Objective: In this video article, we describe the technique of harvesting bilateral posterior nasal septal flaps and overlaying the flaps in a double breasting technique to cover the skull base defect...

Purpose: To understand and remove the source of a phase-wrap artifact produced by residual contrast agent in the intravenous line during acquisition of bilateral axial 3-T dynamic contrast material-enhanced (DCE) breast MRI. Materials and Methods: A two-part study involved a phantom experiment, followed by an institutional review board approved clinical intervention, to evaluate the phase-wrap artifact at MRI. A phantom model evaluated artifact production by using an intravenous line filled with fluids with varying concentrations of gadolinium-based contrast agent (0, 0...

We present the case of an 18-yr-old female with 4 mo of progressive vision loss in the left eye. She underwent a computed tomography (CT) and magnetic resonance imaging (MRI), which revealed a large mass in the sphenoid sinus, sella, and anterior cranial fossa. This mass was T1 isointense, with heterogenous enhancement noted on T1 with gadolinium sequences. The mass was found to have calcifications and cystic portions on T2-weighted MRI scans and CT-based imaging. She underwent an endonasal endoscopic approach for resection of the mass...

An ependymoma of the sella turcica and the suprasellar region has been described by only 10 reports in the available literature. We describe similar pathology in a 70-year-old woman who presented with dementia and visual disturbance. Magnetic resonance imaging with gadolinium revealed a mixed contrast-enhanced lesion(maximum diameter 3.5 cm)in the sella turcica and suprasellar area associated with a noncommunicating hydrocephalus. The patient was preoperatively presumptively diagnosed with a craniopharyngioma...

A 68-year-old woman presented with profound vision loss of 2-month duration in the right eye and 1-week duration in her left eye. This occurred in the context of craniopharyngioma that was twice resected and irradiated (54 Gy in 30 fractions) 9 months before her presentation. Ophthalmological examination revealed hand motion vision in the right eye and light perception vision in the left eye with poorly reactive pupils and bilateral optic disc pallor. A non-contrast MRI of the brain and sella showed significant reduction of the sellar mass...

Hemangioblastoma (HBL) in the suprasellar region is very rare and a few cases have been reported. Suprasellar HBL without von Hippel-Lindau disease is much rarer. A 76-year old male patient presented progressively deteriorating visual disturbance. MRI demonstrated solid suprasellar mass of 20 mm in diameter, broadly based to planum sphenoidale and diaphragm sella and dural tail sign after the administration of gadolinium diethylene triamine penta-acetic acid (Gd-DTPA). Preoperative diagnosis was meningioma...

BACKGROUND The clivus is a depression in the anterior occipital bone of the skull base, posterior to the dorsum sellae, at the junction with the sphenoid bone. Chordoma is a rare tumor arising from embryonic remnants of the notochord and can be locally aggressive with a tendency to recur. The optimal management of this rare tumor remains controversial. A report of a case of recurrent chordoma of the clivus is presented to illustrate the value of volumetric three-dimensional (3-D) reconstruction with computed tomography (CT) and magnetic resonance imaging (MRI) to determine optimal surgical management...

OBJECTIVE: Cushing's disease during pregnancy is associated with an increased risk for maternal and fetal complications. In recurrent Cushing`s disease following transsphenoidal surgery, and when re-operation is not feasible, medical treatment is usually considered. Cabergoline was found to be effective in reducing hypercortisolism in Cushing's disease. Evolving data concerning the safety of cabergoline use during pregnancy show no significant increase in the rate of complications during pregnancy or the postnatal period...

Three cases of intracranial angioleiomyoma (ALM) in our neurosurgery center are reported in detail. ALM is a benign soft tissue tumor comprised of mature smooth muscle cells and a prominent vascular component, which is extremely rare as a primary intracranial lesion. Altogether, only 12 cases were recorded in the literature to date, to the best of our knowledge. Case 1 is the second report of intra-sella ALM, a 51-year-old woman presented with visual deterioration for 2 months. An MRI showed an intra-sella 3-cm tumor, partially flame-like, enhanced with gadolinium...

A 64-year-old male presented with an incidental tumor in the sella turcica during a brain medical checkup. Because he lacked any neurological symptoms or signs of pituitary dysfunction, the patient did not undergo surgery. Three years later, visual disturbances developed, including poor eyesight and visual field defects. The response to the growth hormone(GH)releasing peptide-2 demonstrated severe GH deficiency. MRI revealed an enlarged tumor appearing as a mosaic pattern of high and very low intensity on T2-weighted imaging...

Meningiomas account for about 1% of sellar masses. Although they can mimic pituitary adenomas, they are more vascularized and invasive. To gain insights that would enhance our ability to establish a pre-surgical diagnosis of meningioma, we performed a retrospective study of these tumors. Query of the surgical pathology database identified 1,516 meningiomas operated at out institution between January 2000 and May 2012. Cases were matched to the radiology database to identify a strictly defined sellar and/or suprasellar location...

BACKGROUND: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management...

Lung carcinomas have a high propensity to metastasize to the liver, adrenal, bone or brain. However, certain atypical intracranial sites may occur. We report two cases of adenocarcinoma of the lung discovered by peculiar brain metastases. The first patient presented with an orbital apex syndrome due to a metastasis to the cavernous sinus with intraorbital extension. The second patient presented with headache and visual loss due to metastasis to the pituitary. Intrasellar and parasellar metastases are rare sequelae of pulmonary neoplasms...

BACKGROUND: Pituitary adenomas are a common cause of endocrinal dysfunction, which comprise 10-20% of all intracranial tumors. Although almost all of them arise within the sella turcica, there are some rare cases in which a pituitary adenoma is located outside the intrasellar region, so it is defined as an ectopic pituitary adenoma (EPA). CASE DESCRIPTION: We described a case of a 31-year-old male with a serum prolactin (PRL) value of 240 ng/ml Magnetic resonance imaging (MRI) showed a space-occupying mass within the sphenoid sinus (SS) which partially enhanced by gadolinium...