Craniopharyngioma
Dongyou Liu in Tumors and Cancers, 2017
Craniopharyngioma is a rare, benign tumor of the sellar region that consists of two recognized histopathologic variants: adamantinomatous and papillary. The sellar region is the area around the sella turcica, which is a saddle-shaped, bony depression within the sphenoid bone at the skull base, and in which the pituitary gland is situated. Above the sellar region lies the suprasellar cistern, with several vital structures traversing the area. Craniopharyngioma has an estimated incidence of 0.5-2 cases per million per year and accounts for 2-5 percent of all primary brain tumors. Despite its slow growth, craniopharyngioma can put pressure on the brain, the optic chiasm, and the pituitary gland, leading to clinical symptoms such as headache, visual impairment, endocrine deficits, balance disorder, dry skin, fatigue, fever, hypersomnia, lethargy, myxedema, nausea, vomiting, short stature, polydipsia, polyuria, and postsurgical weight gain. Diagnosis of craniopharyngioma involves physical exam, medical history review, neurological exam, etc.
Neuroimaging
Sarah McWilliams in Practical Radiological Anatomy, 2011
RADIOLOGICAL ANATOMY The skull (Figs 1.1–1.3) The skull is made up of the frontal bone, occipital bone, parietal bones, temporal bone and sphenoid bone. The lambdoid suture lies posteriorly between the occipital bone and the temporal and parietal bones. The sagittal suture lies in the midline. The coronal suture lies transversely between the frontal and parietal bones. The bregma is the most superior point at the junction of the coronal and sagittal sutures. The lambda is the junction of the lambdoid and sagittal sutures. The clivus forms the anterior wall of the foramen magnum and part of the skull base; it is formed by the occipit and the sphenoid. The superior aspect of the clivus forms the posterior clinoid processes or dorsum sellae. The anterior clinoid processes arise from either side of the anterior aspect of the pituitary fossa or sella turcica. They are more widely spaced than the posterior clinoid processes. The crista galli is the perpendicular superior projection of the cribriform plate of the ethmoid bone seen on an anteroposterior (AP) view. The skull is divided into three cranial fossas: anterior, middle and posterior.
Beaten Silver (Beaten Brass) Pattern
Michael E. Mulligan in Classic Radiologic Signs, 2020
Leo Davidoff 1 , in 1936, studied the skull roentgenograms of nearly 2500 normal individuals in an attempt to understand the significance of the appearance of the convolutional markings upon the inner table of the skull. This work was done at the Neurological Institute in New York. The patients had an age range from 3 months to 18 years. The ‘appearance of patchy areas of diminished density in the roentgenograms of the skull in certain cases is a matter of frequent experience. These areas are assumed to be the result of impressions of the cerebral convolutions upon the inner table of the skull, and when accompanied by pressure atrophy of the sella turcica or separation of the cranial sutures, or both, are indications of increased intracranial pressure. When the intracranial pressure is great, these markings may resemble beaten silver.’ 1 ( Figure 1 ). He emphasized that this appearance could be normal in growing children who did not have any other evidence of increased intracranial pressure. The presence of other signs of increased intracranial pressure was most important. Figure 1 ‘Skull X-ray of 7-year-old child’ 1 showing beaten silver or brass pattern. Reprinted from Davidoff. Convolutional digitations seen in the roentgenograms of immature human skulls. Bull. Neurol. Inst NY, 5, 61–71
A cone beam computed tomographic evaluation of the size of the sella turcica in patients with cleft lip and palate
Published in Journal of Orthodontics, 2017
Maryam Paknahad, Shoaleh Shahidi, Iman Khaleghi
Objective: Changes in the size of the sella turcica are frequently related to pathologies and syndromes. The aim of this was to compare the sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate and non-cleft subjects. Methods: Cone beam computed tomography (CBCT) images of three groups consisted of 20 patients with unilateral cleft lip and palate; 20 patients with bilateral cleft lip and palate and a control group consisting of 20 non-cleft subjects were the research population in this pilot study. The sella turcica linear dimensions in terms of length, depth and diameter were measured for all subjects. One-way ANOVA test was used to determine any significant differences among the three groups for the measured parameters. Results: The length, depth and diameter of sella turcica were found to be significantly smaller in the unilateral and bilateral groups compared with the normal age and gender matched group. No significant differences were found in the measured variables between the unilateral and bilateral cleft patients. Conclusion: CBCT images showed a greater likelihood of abnormal sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate. Therefore, the sella turcica dimensions may have an intrinsic relationship to the cleft condition.
Absent Sella Turcica: A Case Report and A Review of the Literature
Published in Fetal and Pediatric Pathology, 2013
Viktoriya Paroder, Todd Miller, M. Michael Cohen, Alan Lawrence Shanske
Absent sella turcica is an extremely rare and dramatic radiographic finding. It may be isolated or occur in the presence of other anomalies, often involving the adenohypophysis. Our evaluation of a female infant with multiple anomalies including absence of the sella turcica, a normal pituitary in the craniopharyngeal canal, normal pituitary function, choanal atresia and anomalies of the appendiceal skeleton prompted a review of the occurrence and biology of an absent sella turcica.
Sella turcica metastasis from follicular carcinoma of thyroid
Published in Neurological Research, 2004
Selcuk Yilmazlar, Hasan Kocaeli, Teoman Cordan
A case of metastasis to the sella turcica from a follicular adenocarcinoma of the thyroid gland is presented. Metastasis to this site is rare and review of the literature reveals only 12 cases of metastatic thyroid carcinoma involving the sella turcica and pituitary gland. The optimal treatment strategy is still to be determined. A 43-year-old woman presented with headache, nausea, visual impairment and galactorrhea. An MRI scan of the cranium revealed an enhancing destructive sellar lesion. The patient underwent transsphenoidal removal of the lesion to alleviate visual loss. The histological features of the sellar tumor were identical to those of a follicular adenocarcinoma partially removed from the thyroid gland 22 months earlier. Total thyroidectomy followed by three courses of iodine-131 ablation enhanced with synthetic thyrotropin and thyroid hormone suppression therapy was instituted. The post-operative course was satisfactory with improved vision and ceased galactorrhea. This case was successfully treated with a combination of surgical removal, iodine-131 ablation and hormone suppression therapy, which resulted in disease control duration of four years. Sella turcica metastases of thyroid carcinoma are exceedingly rare and currently there are no established therapeutic guidelines.