Tuberculum sellae meningioma magnetic resonance imaging [Neurosurgery Wiki]

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====== Tuberculum sellae meningioma magnetic resonance imaging ======

[[Magnetic resonance imaging]] has supplanted [[computed tomography]] as the imaging modality of choice for [[sellar lesion]]s and [[parasellar lesion]]s, but unenhanced MR imaging does not reliably distinguish between all [[tuberculum sellae meningioma]]s and [[pituitary macroadenoma]]s. Accurate differentiation between these alternative diagnoses of a suprasellar mass is important because a tuberculum sellae meningioma always requires a [[craniotomy]], whereas a [[transsphenoidal]] route is preferred for removing most pituitary macroadenomas. The gadolinium-enhanced MR images of seven patients with tuberculum sellae meningioma and seven with pituitary macroadenoma were reviewed retrospectively. Although no specific radiological feature was pathognomonic, a combination of several features allowed the correct diagnosis in all cases. Three characteristics of tuberculum sellae meningiomas distinguish them from pituitary macroadenomas: 1) bright homogeneous enhancement with gadolinium, as opposed to heterogeneous, relatively poor enhancement; 2) a suprasellar rather than a sellar epicenter of tumor; and 3) tapered extension of an intracranial dural base. Each of these findings can be subtle, but careful examination of gadolinium-enhanced, high-quality, thin section coronal and sagittal MR images of the [[parasellar region]] for this constellation of findings will allow the correct preoperative [[diagnosis]] in patients with either of these tumors
((Taylor SL, Barakos JA, Harsh GR 4th, Wilson CB. Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma. Neurosurgery. 1992 Oct;31(4):621-7; discussion 627. doi: 10.1227/00006123-199210000-00002. PMID: 1407446.)).
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{{::tuberculumsellaemeningiomamri.jpg?500|}}

Gadolinium-enhanced sagittal and coronal [[T1 weighted image]] demonstrating a [[tuberculum sellae meningioma]] with [[suprasellar]] and [[sella]]r involvement.