Primary melanoma of the sella turcica is very unusual with only four previous cases reported in the medical literature. This report describes a 47-year-old man whose headaches, endocrine dysfunction and neuro-imaging suggested a haemorrhagic pituitary macroadenoma. The histological examination showed a haemorrhagic melanoma. An extensive search for a primary source proved negative. The patient underwent three neurosurgical interventions and radiotherapy and died two years after presentation. Previous cases of primary melanoma in the pituitary region, as well as various hypotheses for this unusual site of origin are reviewed, followed by a discussion of the particular characteristics of melanin pigments on MRI. This case report illustrates that primary sellar melanoma may present as a haemorrhagic adenoma of the pituitary gland and have an unfavourable outcome despite repeated neurosurgical interventions and radiation therapy.

✓ A technique of selective anterior cordotomy with the operative microscope is described. The anterior approach is preferred on anatomical grounds since the anterior quadrant is in full view without manipulation of the cord and because the anterior spinal artery is readily identified, allowing the cut to be close to the midline and in an avascular space. The benign postoperative course of the technique in poor risk patients is emphasized.

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