PMC8060105_01
Precontrast T1-weighted axial image showing a suprasellar tumor compressing the optic pathway (a). Gadolinium-enhanced axial image showing an enhanced rim of the tumor (b). The contents of the tumor are of low signal intensity on the T1-weighted image (a) and Gadolinium-enhanced image (b), slightly high on T2-weighted image (c), iso on fluid-attenuated inversion recovery image (d), and relatively high on diffusion-weighted image (e) and T2*-weighted image (f). Contrast-enhanced computed tomography showing a cystic lesion (g) from the sella turcia to the suprasellar space (h). Calcified components are not found in it. Postcontrast magnetic resonance imaging shows the enhanced cystic wall displacing the optic chiasm upward (i). This cystic lesion occupies the suprasellar region but not the third ventricle (h), (j). Goldmann perimeter reveals irregular bitemporal hemianopsia (k). Constriction of the visual field is more predominant in the right eye than in the left eye (k).
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fig1
Magnetic resonance (MR) imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm superiorly (Figures 1(a)-1(f)). Postcontrast computed tomography (CT) showed the enhanced rim of the sellar-suprasellar tumor without apparent calcification (Figures 1(g) and 1(h)). Postcontrast MR images demonstrated the enhanced rim of the tumor, indicating that the tumor was a cystic lesion with some contents (Figure 1(b)). Reconstructed CT and MR images revealed that the cyst corresponded to the pituitary stalk (Figures 1(g)-1(j)). Goldmann perimeter (GP) revealed irregular bitemporal hemianopsia predominantly in the left eye (Figure 1(k)).
The intercavernous sinus has been cut after cauterization (a). A Y-shaped dural incision is made (a). The cyst wall is found above the pituitary gland (b). Vascular streaks are found on the cyst wall, indicating the pituitary stalk is tumorized (b). The cyst is displacing the optic chiasm (c). The cyst contents are aspirated via a long needle (d). After the aspiration (d), the cyst is shrunken so that the working space in this tumor resection is secured. An indentation is observed in the inferior surface of the decompressed optic chiasm (e). The solid cyst contents appeared as tissue debris, keratin, solid cholesterol, and their mixtures, which were meticulously removed (f). Since the cyst wall is the tumorized pituitary stalk, the cyst was gross-totally removed from the intrasellar part to the infundibular part (g). The opened skull base (h) is reconstructed with a fat-on-fascia graft plug.
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fig2
The dura was opened (Figure 2(a)) to expose the tumor and the pituitary gland (Figures 2(b) and 2(c)). Prior to the resection, the cyst was punctured with a long needle (Figure 2(d)). After the cyst aspiration (Figure 2(e)), not to disseminate the cyst contents for prevention of chemical meningitis, the cyst was opened and dissected (Figure 2(f)). Since the cyst wall was the tumorized pituitary stalk, the cyst was gross-totally removed from the intrasellar part to the infundibular part (Figure 2(g)). The opened skull base (Figure 2(h)) was reconstructed with a fat-on-fascia graft plug.
Histopathological examination shows features of the dermoid cyst. The lining is typically a squamous epithelium adjacent to glial tissues with inflammation (a). The cyst lumen contains keratin (b). CW: cyst wall and K: keratin.
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fig3
Histopathological analysis confirmed the cyst as an epidermoid cyst (Figure 3).
The displaced optic chiasm (a, b, c, and d) is successfully decompressed, and the cyst is totally resected (e, f, g, and h) on MR imaging at 4 months (19 weeks) weeks after surgery.
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fig4
MR imaging at 4 months (19 weeks) after surgery showed that the displaced optic chiasm (Figures 4(a)-4(d)) had been successfully decompressed and the infundibular dermoid cyst was totally resected (Figures 4(e)-4(h)).