Intrasellar Fat Graft Gains Weight with the Patient: Imaging Features

Abstract

We describe a 56-year-old man with an intrasellar craniopharyngioma who underwent transphenoidal resection and abdominal fat grafting of the dural opening. Follow-up MRI showed hypertrophy of the sellar fat graft concurrent with the patient's weight gain. To our best of knowledge sellar fat graft hypertrophy has not been reported before.

Fat Hypertrophy as a Complication of Fat Transfer for Hemifacial Atrophy

“…Reports of fat hypertrophy were not limited to the face but manifested in fat transfer procedures for various indications. Recipient sites included the thigh, pharyngeal wall, dural opening and penile sheath [8][9][10][11] . Fat hypertrophy was also implicated in relation to a rectus abdomens deep inferior epigastric perforator flap for pharyngeal reconstruction, which manifested as a painless enlarging neck mass 12 .…”

“…Consequences of increased graft bulk were dependent on the recipient site. Presenting complaints included obstructive sleep apnoea after pharyngeal wall fat grafting for velopharyngeal incompetence 9 , inability to have sexual intercourse due to reconstruction of the cutaneous penile sheath 11 , and an enlarging mass on follow-up imaging following reconstruction after tumour excision which had to be differentiated from tumour recurrence 10,12 . There was significant psychosocial burden as a consequence of the fat hypertrophy, as was reported in our patient.…”

Acute Bitemporal Hemianopsia Following Transsphenoidal Pituitary Adenoma Resection With Fat Graft

“…To prevent these complications, an autologous abdominal fat graft is often used to reconstruct the sellar floor and achieve watertight closure of the cranial base (3). The risk of fat graft hypertrophy with patient weight gain has previously been reported; however, it is a rare and delayed complication (4). We describe a case in which a patient developed BHA following transsphenoidal resection of her pituitary adenoma.…”