Suprasellar Cystic Meningioma Simulating Craniopharyngioma: A Case Report

ABSTRACT

An unusual case of meningioma with a large cyst on the sellar region which was misinterpreted to craniopharyngioma was reported. A 6-year-old boy was admitted to our hospital on May 8, 1980 because of headache, blurred vision and walking disturbance. On admission, neurological examination revealed marked diminished visual acuity associated with optic atrophy in both eyes, gait disturbances, incoordination and precocious puberty. Plain skull film showed marked digital markings and seperation of the coronal suture. Right carotid angiography in AP view revealed widening of the U-loop and space occupying lesion on the suprasellar region in lateral view. Neither detection of the tumor feeding artery nor tumor stain was seen. Conary ventriculography revealed marked dilation of the both lateral ventricles and blockage of the foramen of Monro. CT scan disclosed a well defined low density area and small multilobulated cysts in the suprasellar region. The margin of the tumor and low density area were markedly enhanced by contrast media. At operation, the tumor was found to consist of a yellowish brown nodule firmly adherent to the diaphragma sellae and a large cyst. The tumor was partially removed together with the whole cyst wall. The resected nodule was relatively hard and had multiple small cysts in it's cut surface. Postoperative course was uneventful. The neurological deficits except precocious puberty were much improved on discharge time. Reviewing the literature and the pathogenesis of cystic change in meningiomas were discussed.