Elsevier

Surgical Neurology

Volume 63, Issue 4, April 2005, Pages 394-397
Surgical Neurology

Pituitary
Epidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report

https://doi.org/10.1016/j.surneu.2004.02.039Get rights and content

Abstract

Background

Epidermoids of the central nervous system are rare tumors. They are usually found in the fourth decade of life and most commonly off midline in the cerebellopontine angle. We report here a rare case of an epidermoid arising from the sphenoid sinus with extension into the sella and adjacent structures with acute onset of neurological deficit. The significance of the clinical presentation resembling pituitary apoplexy and magnetic resonance imaging (MRI) findings is noted.

Case Description

A 25-year-old man presented with acute severe headache, diplopia, and decreased visual acuity. Examination revealed right-sided ptosis and paresis of the third cranial nerve on the right side. Computed tomography and MRI were suggestive of a slow-growing sphenoid sinus mass with extension into the sella. The sublabial transsphenoidal approach was used to remove the mass under direct visualization. The patient's neurological status improved to baseline both subjectively and objectively after the operation.

Conclusion

Epidermoids, although rare, should be considered as part of the differential diagnosis when evaluating lesions of sphenoid sinus or sellar origin.

Section snippets

Background

Epidermoids typically occur between the ages of 20 and 60 with a peak incidence in the fourth decade. There is no gender predilection [9], [10]. They comprise 1% of all intracranial tumors [23] and are usually found off midline in the extraaxial, subdural regions, most commonly the cerebellopontine angle cistern (40%-50%), followed by the parasellar/middle fossa space (10%-15%) [1], [3], [10]. About 10% are extradural, most commonly the cranial diploic spaces [21] of the frontal, parietal, and

Case description

A previously healthy 25-year-old man presented with acute severe headache and worsening diplopia. He denied any nausea, vomiting, weakness, numbness, or constitutional symptoms. Examination revealed an afebrile well-nourished young male with right-sided ptosis and paresis of the right third cranial nerve. Visual acuity was 20/60 OD and 20/40 OS by handheld acuity testing. No gross visual field defects were found. The rest of the neurological examination findings were normal. Complete blood

Discussion

In 1829, Cruveilhier [7] reported the first description of the “tumeurs perlees.” Several years later, after recognizing the presence of cholesterol crystals in a diploic epidermoid, Müller [13] introduced the term “cholesteatoma,” but Virchow [25] soon recommended the abandonment of the term after realizing cholesterol was neither essential nor constantly seen in these tumors.

The location of this tumor with sellar extension and the acute neurological deterioration caused by such a slow-growing

Conclusion

Epidermoids should be considered as part of the differential diagnosis of sphenoid sinus or sellar region masses. Despite being slow growing, they can present acutely with sudden neurological deficit requiring immediate neurosurgical intervention.

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