Meningiomas account for about 1% of sellar masses; they can mimic macroadenomas. Although majority are WHO grade 1 tumours, these are technically challenging due to high vascularity and often present with visual disturbance. Certain radiological features might help to suspect sellar/suprasellar meningiomas. We present two cases sellar meningioma.
Case 1: A 48-year-old-female with presumed diagnosis of non-functioning pituitary macroadenoma (NFPA) with mild hyperprolactinaemia was referred with hypopituitarism (on hydrocortisone, GH, and HRT). Repeat contrast MRI in 2013 suggested a possibility of sellar meningioma due to intense contrast enhancement, encroachment onto planum sphenoidale with associated bulging of roof of sphenoid sinus. Later she underwent successful transsphenoidal removal of the mass after developing subtle visual field defect. Histology confirmed grade 1 meningioma.
Case 2: A 62-year-old lady came with history of head injury 6 months ago when she had a fall and since then she had noticed a lump on her head. MRI and CT scan brain confirmed the presence of an interosseous and falcine lesion encroaching the surrounding brain area. She had elective excision of tumour. Histology showed a meningioma attached to dura without evidence of atypia or brain invasion. The bony part of specimen is undergoing decalcification.
Conclusion: Sellar meningiomas can be suspected preoperatively based on MRI signal characteristics, dural tail and evidence of hyperostosis on CT. Compared to pituitary adenomas there is increased risk of bleeding during surgery and hypopituitarism postoperatively.