PMC8385128_01
Sagittal (A) and Axial (B) non contrast Head CT showing a hypodense lesion in the sella/suprasellar region (white arrow), with associated scattered hypodense globules along the parasagittal sulci and left sylvian fissure (red arrows) (C) Sagittal T1 fluid-attenuated inversion recovery (FLAIR), (D) 3D T2 fast spin-echo (FSE), and (E) Coronal T1-weighted MRI showing a ruptured sellar dermoid cyst with pathognomonic blood-fat-CSF level (white arrow).
fsurg-08-714771-g0001.jpg
PMC8385128_01_fsurg-08-714771-g0001.jpg
F1
MRI with contrast showed a non-enhancing 2.5 x 2.3 x 2.3 cm suprasellar mass with fluid-fluid level and associated mass effect on the optic chiasm, pituitary gland, and inferior medial aspect of the bilateral frontal lobes. Multiple areas of scattered foci of increased T1 signal within the left and right convexity sulci and sylvian fissure were noted, suggestive of disseminated subarachnoid fat due to a ruptured dermoid cyst (Figure 1).
(A) Contrast-enhanced Sagittal T1 image 6 months after craniotomy, showing decompression of the sellar region with resolved mass effect over the optic pathway. (B) Axial T2 MRI at 6 months after surgery, showing normal size of ventricles and sulci.
fsurg-08-714771-g0002.jpg
PMC8385128_01_fsurg-08-714771-g0002.jpg
F2
By the 6-month follow-up, all neurological and visual deficits had resolved, and a repeat MRI of the brain showed stable sella decompression and stable ventricular size (Figure 2).