Computed Tomographic Findings in Juxtasellar Tumors.

Jung, Hee Won; Sim, Bon Sung

Original Article

Journal of Korean Neurosurgical Society 1978;7(2): 325-340.

Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea.

ABSTRACT

Twenty three consecutive patients admitted to our department with the suspicion of juxtasellar tumor were subjected to computed tomographic examinations. The diagnostic accuracy of CT scan was compared to that of plain skull x-ray, carotid angiography, and pneumoencephalography. The characteristic CT findings of pituitary tumors, carniopharyngiomas and parasellar meningiomas were observed, including their contrast enhancement patterns. In pituitary adenomas, the author evaluated the enlargement of the sella turcica by calculating the sella turcica size index with the use of measured interclinoid distance on CT Polaroid pictures. The results were as following: 1) CT gave the highest accuracy of various diagnostic tools, indicating that CT has become the screening method of choice in the detection of juxtasellar masses along with its another advantage of noninvasiveness. 2) Pituitary adenomas showed significant enlargement of the sella turcica according to the author's sella turcica size index. Size index above 2.5 was thought to have to be interpreted as an abnormally enlaged sella turcica. 3) Suprasellar cistern was visualized in 87% of 23 normal CT scans as a pentagone(48%) or a hexagone(43%) or a tetragone(9%), but it was identified only in 51% of supratentorial mass lesions. 4) Pituitary adenomas invariably showed positive contrast enhancement(100%), but rarely contained calcification(10%) or dilatation of ventricles(8%). 5) Craniopharyngiomas generally contained large dense calcifications or partly calcified peripheral ring(83%) and cyst formation(83%). Contrast enhancement(67%) and hydrocephalus(50%) were often found, but enlargement of the sella turcica was unusual(3%). 6) As compared to the tendency of anterolateral growth in pituitary adenomas, craniopharyngiomas were often found to extend posterosuperiorly. 7) It was advantageous to perform the operation at the side of predominant location of the tumor in suprasellar cistern or at the side of the cystic portion of the tumor. 8) A case of hypothalamic glioma was operatively verified that appeared as an isodense suprasellar mass, showing marked contrast enhancement.