Most chordomas involving the sellar region are parasellar or suprasellar, and largely or entirely sellar lesions are very rare. The authors report a case which chordoma involve pituitary fossa and surrounding structures and presented as nonfunctioning pituitary adenoma. Successful surgical removal was conducted via endonasal endoscopic approach. The pathology exhibited the typical histological patterns and immunophenotype of chordoma. The authors present a rare case of sellar chordoma and review the literature on that.
Chordoma* ; Pathology ; Pituitary Neoplasms* ; Sella Turcica

In the past many authors have contributed most of the fundamental observations of alteration in the sella turcica resulting from raised intracranial pressure and hydrocephalus, and some authors have attempted to distinguish different types of sella change specific to particular pathology. The author has observed upon the change of sella with proved hydrocephalus in 57 patients(45 cases of obstructive hydrocephalus and 12 cases of communicating hydrocephalus) during the period from Jan. 1967 to July 1973 at the Department of Neurosurgery, Seoul National University Hospital. Results are as follows: 1. Among 57 cases in total; no evident abnormalities were seen in 18 cases(32%); erosion and circular expansion at the posterior portion of sella turcica in 36 cases(63%); erosion of the posterior clinoid processes in 31 cases(53%). These changes were more often observed in the cases over 15 years of age than under 15 years of age as well as in the cases of obstructive hydrocephalus than communicating one. 2. The changes of sella related to the site of lesion in obstructive hydrocephalus were as follows; radiologically normal sella were more often observed in the 3rd ventricular lesion than posterior fossa lesion, erosion and circular expansion of the posterior portion of sella in the posterior fossa lesion, and thinning and pointing of dorsum sella in the 3rd ventricular lesion. These changes of sella were not relevant to the age. 3. The changes of sella related to the duration of symptoms of raised intracranial pressure in the obstructive pattern were that the severity of changes was relatively proportionate to the duration; most of the changes were observed around the 6 months of duration regardless of the age. 4. The evident sellar enlargement was observed in 19 out of 36 cases with erosion and circular expansion of the posterior portion of sella, and sellar elongation in 4 cases. 5. Among 27 cases of the obstructive pattern being studied by ventriculogram, cases with anterior end of 3rd ventricle apart from the dorsum showed sellar changes in 40%, those touching the dorsum in 58%, and those extending into sella in 100%. The main findings in the latter two groups were the erosion and circular expansion of the posterior portion of the sella turcica. 6. The raised intracranial pressure did not produce the sellar changes without the change of vault in those cases below 15 years of age.
Hydrocephalus* ; Intracranial Pressure ; Neurosurgery ; Pathology ; Sella Turcica* ; Seoul

Adult ; Female ; Hemangioblastoma ; pathology ; Humans ; Sella Turcica ; pathology ; Skull Neoplasms ; pathology

Although chordomas are midline tumors, primarily intrasellar chordomas are extremely rare. In this report, the authors describe the case of a 68-year-old female with partial abducens nerve palsy in the right eye due to the intrasellar cystic tumor. After endonasal trans-sphenoidal surgery, intraoperative and histopathological findings confirmed the co-occurrence of an entirely intrasellar chordoma and pituitary adenoma. To our knowledge, the present case is the third reported case of an intrasellar chordoma with a pituitary adenoma.
Abducens Nerve Diseases ; Aged ; Chordoma* ; Female ; Humans ; Pathology ; Pituitary Neoplasms* ; Sella Turcica

The authors present a very rare case of an intrasellar cavernous hemangioma that mimick a pituitary macroadenoma radiologically. A 63-year-old male patient was admitted with visual field defect and clinical manifestations of pituitary failure. MR image revealed intrasellar gadolinium-enhancing tumor with parasellar extension suggesting pituitary macroadenoma. But pathology was cavernous hemangioma. It was suggested that cavernous hemangioma should be included in the differential diagnosis of pituitary mass.
Diagnosis, Differential ; Hemangioma, Cavernous* ; Humans ; Male ; Middle Aged ; Pathology ; Pituitary Neoplasms ; Sella Turcica ; Visual Fields

Female ; Granuloma ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Sella Turcica ; pathology ; Xanthomatosis ; diagnosis

It has been reported in autopsy that most of the patients with Korean hemorrhagic fever had necrotic areas inthe anterior lobe of the pituitary gland. The high resolution CT of sella was performed to demonstrate thepossible pituitary necrosis in consecutive 13 patients with Korean hemorrhagic fever. Only 3 patients demonstrate normal sellar findings. Ten (77%) out of 13 cases reveal abnormal findings; 2 patients show typical empty sellar and the rest (8 patients) reveal localized low denstiy area in the anterior portion of the sella turcica, which may be from partial empty sella, pituitary infarction or other unknown pathology. The low denisties within the sella will be discussed.
Autopsy ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Infarction ; Necrosis ; Pathology ; Pituitary Gland ; Sella Turcica

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.
Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Meningioma/*diagnosis/pathology/surgery ; Middle Aged ; Pituitary Neoplasms/*diagnosis/pathology/surgery ; Sella Turcica/*pathology

OBJECTIVETo investigate the magnetic resonance imaging (MRI) manifestations of sellar region of children and adolescents with pituitary stalk interruption syndrome (PSIS).

METHODSThirty-one PSIS cases were selected from February 2001 to August 2010 in Peking Union Medical College Hospital. MRI images were collected to calculate the volume and coronary area of the pituitary based on its measured height, width, and anteroposterior diameter. The results of the measurement were retrospectively analyzed together with clinical data.

RESULTSThe patients in this study included 28 males and 3 females, aged 16.5∓3.8 years (range, 6~25 years). MRI images showed pituitary stalk rupture associated with ectopic posterior pituitary in 16 cases, significantly thinner or unclear pituitary stalk in 15 cases, in which 7 cases were found with vacuole turcica. All the 31 patients presented with reduced pituitary volume and dysfunction of anterior pituitary.

CONCLUSIONPSIS may show pituitary stalk interruption with ectopic posterior, thinning or unclear of pituitary stalk, and with a variety of anterior pituitary hormone deficiency.

Adolescent ; Adult ; Child ; Female ; Humans ; Hypopituitarism ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; pathology ; Retrospective Studies ; Sella Turcica ; pathology ; Young Adult

OBJECTIVETo summary the microsurgical techniques for removal of huge tuberculum sellae meningiomas through the bi-subfrontal anterior longitudinal fission approach.

METHODSEleven patients with huge tuberculum sellae meningiomas underwent microsurgical removal of the meningiomas between January, 2005 and November, 2009. The microsurgical techniques were summarized, and the factors affecting the prognosis were analyzed.

RESULTSAmong all the patients, 5 had Simpson grade I meningioma removal and the other patients had Simpson grade II removal. No death occurred in these patients. Nine patients showed vision improvement after the surgery, one had no significant improvement, and the other one experienced worsening of vision. Transient postoperative diabetes insipidus occurred in 5 cases.

CONCLUSIONWith satisfactory exposure of Dorsum sellae, bottom of the third ventricle and cavernous sinus, the bi-subfrontal anterior longitudinal fission approach is suggested for treatment of tuberculum sellae meningiomas. The key to improve the GTR and reduce the complication lies in the sequence of the operation, namely resection of the tumoral basement before dissection of the potential arachnoidal space and tuberculum.

Adult ; Aged ; Female ; Humans ; Male ; Meningeal Neoplasms ; pathology ; surgery ; Meningioma ; pathology ; surgery ; Microsurgery ; methods ; Middle Aged ; Sella Turcica ; pathology ; Treatment Outcome