A 47‐year old female with a destructive sellar mass

Abstract

A 47-year old woman from Honduras presented with severe headache and left eye pain. Imaging revealed a sellar mass. Cabergoline side-effects limited treatment and she subsequently developed left eye exophthalmos, ptosis and ophthalmoplegia. CT scans showed increased size and involvement of the cavernous sinus and left orbital apex. Presurgical MR imaging of the brain and dedicated pituitary scan revealed a 2.6 3 3.9 3 3.2 cm heterogeneously enhancing mass on T1-weighted images in the sella turcica with erosion of the surrounding bone and extension into the cavernous sinuses bilaterally (Figure 1a-c). Complete encasement of the left internal carotid artery and superior extension abutting the optic chiasm were also noted. The patient underwent a transsphenoidal approach for resection of the intrasellar component of the mass. Postoperative course was complicated by a right sixth nerve palsy that responded to radiation.