Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

Lubomirsky, Bryan; Jenner, Zachary B.; Jude, Morgan B; Shahlaie, Kiarash; Assadsangabi, Reza; Ivanović, Vladimir

doi:10.1177/19714009211055195

Cited by 8 publications

(33 citation statements)

References 114 publications

(263 reference statements)

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“…10,11 Macroadenomas (>10 mm) are more prevalent than microadenomas, and invade into the cavernous sinus in up to 10% of cases, which increases the risk of surgical morbidity. 10 Secreting pituitary tumors represent a minority of microadenomas, and present with distinct clinical and laboratory features that are often diagnostic. 12 Meningiomas are the most common benign primary central nervous system neoplasm, and frequently demonstrate iso-to hyperdense CT and iso-to hypointense T1-and T2-weighted MRI findings.…”

Section: Common Lesions Of the Sellamentioning

confidence: 99%

“…1,6,10 Calcification is unusual in chordomas but commonplace in chondrosarcomas, appearing in approximately 41% of such lesions. 10 Plasmacytoma describes the singular form of multiple myeloma and appears iso-to hyperintense on T1-and T2-weighted MRI with robust engagement. 1 In contrast to chordomas, plasmacytomas are typically generally centered within the bone, although exophytic lesions or tumors involving the skull base foramina have been reported.…”

Section: Common Lesions Of the Clivusmentioning

confidence: 99%

“…Though histopathological analysis is required for definitive diagnosis, imaging features of clival lesions provide crucial insight in refining the differential and formulating a plan 10 . CT imaging defines bony anatomy, which in turn highlights whether the tumor behavior has been lytic, blastic, erosive, invasive, or simply expansile, among other less common but important changes 2 .…”

Section: Radiographic Assessment Of Clival and Sellar Lesionsmentioning

confidence: 99%

“…Pituitary adenomas are the most common sellar lesions, and typically present with characteristically weak but homogeneous contrast enhancement and isodense/isointense signal, relative to gland 3,10 . On T2-weighted imaging, they typically appear isointense or hyperintense 2 .…”

Section: Common Lesions Of the Sellamentioning

confidence: 99%

“…On T2-weighted imaging, they typically appear isointense or hyperintense 2 . Pituitary adenomas smoothly expand the bony sella and lack calcification, which are key distinguishing features from a sellar meningioma 10,11 . Macroadenomas (>10 mm) are more prevalent than microadenomas, and invade into the cavernous sinus in up to 10% of cases, which increases the risk of surgical morbidity 10 .…”

Section: Common Lesions Of the Sellamentioning

confidence: 99%

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Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Baier,

Cheong,

Shi

et al. 2023

J Neurol Surg Rep

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Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the context of clival metastasis from gastrointestinal malignancy. Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging (MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus extension. An aggressive subtotal endoscopic endonasal resection was performed with removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection. Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative oncologic therapies were recommended, but she elected hospice, and died 3 months after initial presentation. Gastrointestinal clival metastases are exceedingly rare among sellar and clival pathologies, with eight prior cases reported, most of which presented with diplopia from abducens nerve involvement. Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive diseases. We present a consolidated framework for decision-making in these challenging patients, alongside an unusual case example that illustrates the importance of increased suspicion for malignant clinical entities in this setting.

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Section: Common Lesions Of the Sellamentioning

confidence: 99%

Section: Common Lesions Of the Clivusmentioning

confidence: 99%

Section: Radiographic Assessment Of Clival and Sellar Lesionsmentioning

confidence: 99%

Section: Common Lesions Of the Sellamentioning

confidence: 99%

Section: Common Lesions Of the Sellamentioning

confidence: 99%

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Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Baier,

Cheong,

Shi

et al. 2023

J Neurol Surg Rep

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Imaging in neuro-oncology

Beegle,

Murray,

Dodson

2024

Neuropsychological and Psychosocial Foundations of Neuro-Oncology

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Analysis of perceptual errors in skull-base pathology

et al. 2022

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Purpose Medical errors result in significant mortality and morbidity. The purpose of this study is to analyze skull-base errors at a single tertiary institution, identify common anatomic sites of errors, and offer strategies to reduce errors in this region. Methods A Neuroradiology Quality Assurance Database of radiologic errors was searched for attending physician computer tomography and magnetic resonance imaging errors in skull-base pathology from 2014 to 2020. Data were limited to CT and MRI reports. Errors were separated into four subcategories (tumor, trauma, vascular, and congenital) and further divided by relevant anatomic site. Results A total of 90 skull-based errors were identified. Most errors were perceptual (87%), with common study types including MRI Brain (39%) and CT Head (24%). Most common errors were tumors (55%), followed by trauma (24%), vascular (10%), and congenital (7%). Six anatomic sites were identified and encompassed over half of errors (58%): sella, occipital bone, cerebellopontine angle/internal auditory canal (CPA/IAC), foramen magnum and clivus, cavernous sinus, and dural venous sinus. Summary Most of the skull-base errors were perceptual. Placing a strong emphasis on both the pathology and closely examining its critical anatomic site (sella, occipital bone, CPA/IAC, foramen magnum and clivus, cavernous sinus, and dural venous sinus) could potentially reduce up to 60% of errors in these regions.

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Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

Cited by 8 publications

References 114 publications

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Imaging in neuro-oncology

Analysis of perceptual errors in skull-base pathology

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