Suprasellar salivary gland-like pleomorphic adenoma.

Suprasellar salivary gland-Like pleomorphic adenoma is not a common disease and seldom reported so far. We are reporting a case of a 23-year-old man with recurrent suprasellar salivary gland-like pleomorphic adenoma, who underwent an operation of subtotal, subfrontal resection under the wrong pathology diagnosis of benign teratoma in another hospital 4-year-ago. Four years later, he was admitted to our hospital for additional visual loss of the right eye (left, 1.0; right, 0.4) resulting from tumor regrowth. Magnetic resonance imaging revealed that suprasellar extension and compressed optic chiasm resulted in visual disturbance of the patient. The tumor was totally excised and histological examination evidenced the pathological features of intrasellar salivary gland-like pleomorphic adenoma. The patient did not receive any further treatment and he is free from tumor recurrence for 30 months after the operation. From this point of view, clinical prognosis of intrasellar salivary gland-like pleomorphic adenoma was good after total surgical resection.

Surgical Experience of Transsphenoidal Supradiaphragmatic Intradural Approach to Presellar and Suprasellar Lesions

OBJECTIVE: In selected cases, the transsphenoidal approach(TSA) can be extended anteriorly to the tuberculum sellae, chiasmatic sulcus, and planum sphenoidale to obtain direct exposure of the suprasellar cisterns and its contents. We applied this modification of the TSA to various lesions of the presellar and suprasellar areas. We evaluate our clinical experience of this technique and review the related literature. METHODS: From 1999 to 2004, we used the transsphenoidal supradiaphragmatic intradural approachs(TSIAs) in 9 patients who had various lesions at the pre- and suprasellar regions. Concomitant presellar extension of the bone window was performed with the sublabial or transnasal transseptal transphenoidal techniques. After removal of the lesions, sellar or anterior cranial floor was repaired with silicone plate substitute. RESULTS: The TSIAs have been applied in the following cases: four tuberculum sellae meningiomas, two craniopharyngiomas, two Rathke's cleft cysts, and one non-functioning macroadenoma. The complications were one case of visual acuity decrease and one cerebrospinal fluid rhinorrhea. CONCLUSION: The TSIA is easily applicable through a minor modification of the standard TSA. It is suitable for removing lesions located in the presellar and suprasellar area adjacent to the pituitary stalk with minimal brain manipulation and decreased morbidity.

Chordoid Glioma in the Third Ventricle: Case Report

Chordoid glioma of the central nervous system is a recently recognized tumor. It is necessary to be differentiated with the craniopharyngioma or other suprasellar masses due to its clinical and radiologic similarities. The authors report a patient of 47-year-old man with a chordoid glioma in the third ventricle who underwent total removal of the tumor. Preoperatively, the patient showed hypersomnia, memory disturbance, bitemporal hemianopsia, drowsy mental status, and striking weight gain(25Kg) during the last 5-6 months. MRI showed huge homogeneous enhancing mass(5x5x6cm), locating in the sellae extending to the third ventricle and corpus callosum. Tumor was removed via interhemispheric transcallosal interforniceal approach. Histopathologic finding was chordoid astrocytoma characteristically showing GFAP(+), EMA(-), Collagen type IV(-), ki-67(-), p53(-) in immunohistochemical stain and epithelioid cells with eosinophilic cytoplasm, mucinous matrix, high cellularity, no mitosis in H & E stain. Postoperatively, a patient recovered normal mental status, sleep pattern, and vision. Postoperative fractionated radiation therapy was done.

A Case of Suprasellar Immature Teratoma: Case Report

We report a case of immature teratoma arising at the suprasellar region in a 18 year-old-male who presented with bitemporal hemianopsia, nausea and polydipsia. The teratoma is a rare neoplasm consisting of 0.5% to 1.2% of all intracranial tumors. The clinical presentation, radiologic finding, pathology and treatment are briefly described with a review of other cases from the literature in view of clinical features and management.