수술 전 잘못 진단되었던 뇌하수체 선종과 터키안결절 뇌수막종 환자들의 영상학적 소견과 임상 양상에 관한 분석

Abstract

Objectives: Preoperative differentiation of the histologic etiology of masses involving the sellar and suprasellar region is very important because it determines the treatment modalities, surgical approaches, and the degree of resection. We analyze the imaging findings and clinical symptoms of pituitary adenomas and tuberculum sellae meningiomas which preoperatively diagnosed as each other falsely.

Patients and Methods: Preoperative magnetic resonance images (MRI) and angiography findings of 14 patients with pathologically diagnosed as pituitary adenomas or tuberculum sellae meningioma which considered as each other were reviewed retrospectively. For all patients, the clinical history, laboratory data, MRI and results of ophthalmological examinations were retrospectively reviewed. The following features, usually accepted as useful criteria in the differential diagnosis of these lesion were reviewed; Clinical Symptoms, hormonal deficiency, visibility of pituitary stalk, pattern of enhancement, presence of dural tail sign, presence of tumor brushing on the angiographic findings.

Results: All findings except angiographic tumor brushing, were not consistent with each other. All patients presented with visual field defect and have no hormonal deficiency or symptoms. All lesions showed dura based one, no cleavage plane from the pituitary gland or stalk may be due to its large size, and homogeneous enhancement. There was no case of angiographic tumor brushing in pituitary adenoma patients.

Conclusion: Differentiating pituitary adenoma and tuberculum sellae meningioma can be difficult. MRI is the most commonly used method for diagnosis in these lesions. However, it is not sufficient for differential diagnosis for these lesions sometimes. Our results shows angiography finding could be a help to differentiate two pathologies. Preoperative cautious evaluation is essential and we think that angiography could be considered to differentiate two lesions.