Abstract
Purpose of Review
Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically.
Recent Findings
In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment.
Summary
Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.
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References
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• Kinoshita M, Tanaka H, Arita H, et al. Pituitary-targeted dynamic contrast-enhanced multisection CT for detecting MR imaging-occult functional pituitary microadenoma. AJNR Am J Neuroradiol. 2015;36(5):904Y908. https://doi.org/10.3174/ajnr.A4220 Important. An excellent discussion on the mechanics and importance of dynamic contrast imaging for pituitary adenomas and other intracranial lesions.
Minniti G, Flickinger J, Tolu B, Paolini S. Management of nonfunctioning pituitary tumors: radiotherapy. Pituitary. 2018;21(2):154–61. https://doi.org/10.1007/s11102-018-0868-4.
Long-term results of cabergoline therapy for macroprolactinomas and analyses of factors associated with remission after withdrawal. Clin Endocrinol (Oxf). 2017; 86(2):207–213. https://doi.org/10.1111/cen.13240.
Vieira Neto L, Wildemberg LE, Moraes AB, Colli LM, Kasuki L, Marques NV, et al. Dopamine receptor subtype 2 expression profile in nonfunctioning pituitary adenomas and in vivo response to cabergoline therapy. Clin Endocrinol (Oxf). 2015;82(5):739–46. https://doi.org/10.1111/cen.12684.
Endoscopic endonasal approach for craniopharyngioma: the importance of the relationship between pituitary stalk and tumor. J Neurosurg. 2017 29:1–9. https://doi.org/10.3171/2017.4.JNS162143.
Hakizimana D, Poulsgaard L, Fugleholm K. Chemical meningitis from a leaking craniopharyngioma: a case report. Acta Neurochir (Wien). 2018;160(6):1203–6. https://doi.org/10.1007/s00701-018-3530-z.
Kwancharoen R, Blitz AM, Tavares F, et al. Clinical features of sellar and suprasellar meningiomas. Pituitary. 2014;17(4):342Y348. https://doi.org/10.1007/s11102-013-0507-z.
Cugati G, Singh M, Symss NP, et al. Primary intrasellar schwannoma. J Clin Neurosci. 2012;19(11):1584Y1585. https://doi.org/10.1016/j.jocn.2011.09.041.
Bowzyk Al-Naeeb A, Murray M, Horan G, Harris F, Kortmann RD, Nicholson J, et al. Current management of intracranial germ cell tumours. Clin Oncol (R Coll Radiol). 2018;30(4):204–14. https://doi.org/10.1016/j.clon.2018.01.009.
Dutta G, Singh D, Singh H, Srivastava AK, Jagetia A, Sachdeva D. Pituitary fossa chondrosarcoma: an unusual cause of a sellar suprasellar mass masquerading as pituitary adenoma. Surg Neurol Int. 2018;9:76. https://doi.org/10.4103/sni.sni_455_17 eCollection 2018.
Soldatos T, McCarthy EF, Attar S, et al. Imaging features of chondrosarcoma. J Comput Assist Tomogr. 2011;35(4):504Y511. https://doi.org/10.1097/RCT.0b013e31822048ff.
Sen C, Triana AI, Berglind N, et al. Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg. 2010;113(5):1059Y1057. https://doi.org/10.3171/2009.9.JNS08596.
Di Domenico J, Ampie L, Choy W, Lamano JB, Oyon DE, Kesavabhotla K, et al. Sellar plasmacytomas masquerading as pituitary adenomas: a systematic review. J Clin Neurosci. 2018;50:20–3. https://doi.org/10.1016/j.jocn.2018.01.022.
Cerase A, Tarantino A, Gozzetti A, et al. Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay. Neuroradiology. 2008, 50(8):665Y674. https://doi.org/10.1007/s00234-008-0390-x.
Hammoud DA, Munter FM, Brat DJ, Pomper MG. Magnetic resonance imaging features of pituicytomas: analysis of 10 cases. J Comput Assist Tomogr. 2010;34(5):757Y761. https://doi.org/10.1097/RCT.0b013e3181e289c0.
Ampie L, Choy W, Lamano JB, Kesavabhotla K, Mao Q, Parsa AT, et al. Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: a systematic review of literature. Clin Neurol Neurosurg. 2015;138:129–36. https://doi.org/10.1016/j.clineuro.2015.08.011.
• Goode B, Mondal G, Hyun M, Ruiz DG, Lin YH, Van Ziffle J, et al. A recurrent kinase domain mutation in PRKCA defines chordoid glioma of the third ventricle. Nat Commun. 2018;9(1):810. https://doi.org/10.1038/s41467-018-02826-8 Important. A good example of the importance of genomic profiling of gliomas and movement towards molecular subtyping as a means of classification of these tumors.
Morton RP, Tariq F, Levitt MR, et al. Radiographic and clinical outcomes in cavernous carotid fistula with special focus on alternative transvenous access techniques. J Clin Neurosci. 2015;22(5):859Y864. https://doi.org/10.1016/j.jocn.2014.11.006.
Valecha G, Pant M, Ibrahim U, Atallah JP. Immunotherapy-induced autoimmune hypophysitis. J Oncol Pharm Pract. 2017;1:1078155217727142. https://doi.org/10.1177/1078155217727142.
Di Iorgi N, Morana G, Maghnie M. Pituitary stalk thickening on MRI: when is the best time to re-scan and how long should we continue re-scanning for? Clin Endocrinol (Oxf). 2015;83(4):449Y455. https://doi.org/10.1111/cen.12769.
Orakcioglu B, Halatsch ME, Fortunati M, et al. Intracranial dermoid cysts: variations of radiological and clinical features. Acta Neurochir (Wien). 2008;150(12):1227Y1234; discussion 1234. https://doi.org/10.1007/s00701-008-0152-x.
Ren X, Lin S, Wang Z, et al. Clinical, radiological, and pathological features of24 atypical intracranial epidermoid cysts. J Neurosurg. 2012;116(3):611Y621. https://doi.org/10.3171/2011.10.JNS111462.
Yigit M, Seyithanoglu MH, Dundar TT, Sogut O, Yigit E. A rare cause of Headache in the emergency department: intraventricular epidermoid cyst rupture with hydrocephalus. J Clin Med Res. 2016;8(7):560–1. https://doi.org/10.14740/jocmr2585w.
Famini P, Maya MM, Melmed S. Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab. 2011;96(6):1633Y1641. https://doi.org/10.1210/jc.2011-0168.
Ratha V, Patil S, Karmarkar VS, Shah NJ, Deopujari CE. Surgical management of Rathke cleft cysts. World Neurosurg. 2017;107:276–84. https://doi.org/10.1016/j.wneu.2017.07.164.
Wu X, Li G, Zhao J, Zhu X, Zhang Y, Hou K. Arachnoid cyst-associated chronic subdural hematoma: report of 14 cases and a systematic literature review. World Neurosurg. 2018;109:e118–30. https://doi.org/10.1016/j.wneu.2017.09.115.
Semple PL, Jane JA, Lopes MB, Laws ER. Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg. 2008;108(5):909Y915. https://doi.org/10.3171/JNS/2008/108/5/0909.
Wang Z, Gao L, Zhou X, Guo X, Wang Q, Lian W, et al. Magnetic resonance imaging characteristics of pituitary abscess: a review of 51 cases. World Neurosurg. 2018. https://doi.org/10.1016/j.wneu.2018.03.113.
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Abad, A.P. Sellar and Parasellar Pain Syndromes. Curr Pain Headache Rep 23, 7 (2019). https://doi.org/10.1007/s11916-019-0740-x
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DOI: https://doi.org/10.1007/s11916-019-0740-x