PMC4982351_01
Preoperative magnetic resonance imaging of the brain demonstrating a heterogeneous hyperintense T1 and T2 suprasellar mass compatible with acute/subacute hemorrhagic lesion measuring 3.1 x 2.9 x 2.1 cm with no clear evidence of enhancement allowing for intrinsic T1 hyperintensity (a, c, d). There is some adjacent extension of blood products into the right hippocampal sulcus (c). There is also a left-sided moderately-sized venous angioma in the basal ganglia (c, f). This represents a large hypothalamic region/subependymal cavernous angioma with recent hemorrhage and associated surrounding mild edema mainly in the right basal ganglia and thalamus. Moreover, displacement and mass effect on the surrounding structures including basal ganglia, subcapsular brain parenchyma, as well as hypothalamus and displacement of the cerebral peduncle with a mass effect on the midbrain is noted (a, c, d-f). An additional hemorrhagic focus in the left frontal horn of the lateral ventricle close to the foramen of Monro region is also seen (b, c). Specifically, there is a mass effect and anterior displacement of the partially visualized pituitary infundibulum as well as a mild mass effect on the optic chiasm particularly on the right side compressing and displacing it (c, e, f). No additional susceptibility foci are noted
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F1
The pituitary stalk was displaced toward the left. The lesion encased the right posterior cerebral artery and displaced the right carotid artery laterally [Figure 1].
Postoperative magnetic resonance imaging of the brain depicting complete removal of the suprasellar hemorrhagic cavernous malformation with no evidence of a residual lesion or recurrence with some adjacent extension of blood products into right hippocampal sulcus (a-d) and no hemosiderin staining of the ventricular surface on the gradient-echo imaging (e, f)
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F2
Follow-up MRI at 12 months revealed complete removal of the suprasellar hemorrhagic CM with no evidence of a residual lesion or recurrence [Figure 2].