Abstract
Clinicoradiological presentation and management of patients with sellar and suprasellar
tuberculomas (SST) were reviewed. The SSTs of eight patients were divided into five
radiological subgroups: a sellar–suprasellar mass (n = 3); multiple coalescing ring enhancing granulomas (n = 2); an intrasellar abscess (n = 1); pachymeningitis with suprasellar extension (n = 1); and skull-base lesion involving the sella (n = 1). The predominant endocrinopathies were hypogonadism, hypothyroidism and diabetes
insipidus. The management options included surgery utilizing the frontotemporal, transylvian
approach (n = 4) or the transsphenoidal approach (n = 1), stereotactic biopsy and ventriculoperitoneal shunt (n = 1); endoscopic transsphenoidal biopsy (n = 1); and antituberculous therapy (ATT) without surgery (n = 1). All patients received ATT for 15–18 months. Patients with rapid visual deterioration
(n = 2) or with associated intramedullary tuberculoma (n = 2) also received steroids for 2 weeks. At follow-up (range 10 months to 5.5 years;
mean 3.2 years), the radiological response to ATT was evaluated. MRI after ATT showed
resolution of SST in all except two patients with solid lesions. However, these lesions
were smaller and had reduced contrast enhancement on imaging. Thus, SST may present
with five radiological subtypes. Surgery is useful in obtaining histology. Short-term
steroid therapy with ATT may reduce edema and adhesions around the optic nerve when
rapid visual deterioration occurs and relieve symptoms of raised intracranial pressure.
The often-associated hypopituitarism indicates the requirement for preoperative hormonal
evaluation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intrasellar tuberculoma presenting as pituitary apoplexy.Neurol India. 2001; 49: 407-410
- Sellar tuberculoma: report of two cases.Acta Neurochir (Wein). 1997; 139: 523-525
- Hypophysial tuberculoma with hypopitutarism.Am J Med. 1973; 54: 777-781
- Diffuse tuberculosis of the pituitary gland simulating tumor, with postoperative recovery.Arch Neurol Psychiatry. 1940; 44: 1076-1085
- Isolated hypophyseal tuberculoma: case report.Clin Neuropathol. 1988; 7: 311-313
- Pituitary tuberculosis presenting as pituitary apoplexy.Int J Infect Dis. 2006; 10: 338-339
- Sellar tuberculoma: a case report.Pituitary. 2002; 5: 149-153
- A pituitary tuberculoma.J Neurol Neurosurg Psychiatry. 1987; 50: 360-361
- Intrasellar tuberculoma: case report.Neurosurgery. 1987; 21: 721-723
- Intrasellar tuberculoma.Clin Neurol Neurosurg. 1992; 94: 251-252
- Intracranial tuberculoma with difficult preoperative diagnosis case report.Neurol Med Chir (Tokyo). 1991; 31: 991-994
- Thickening of the pituitary stalk: a finding suggestive of the intrasellar tuberculoma.Neurosurgery. 1995; 36: 1013-1016
- Clinical case seminar: an unusual pituitary pathology.J Clin Endocrinol. 1998; 83: 3454-3458
- Intrasellar tuberculoma.Br J Neurosurg. 1994; 8: 179-185
- Diabetes insipidus in sellar–suprasellar tuberculoma.J Clin Neurosci. 2003; 10: 497-499
- Intrasellar tuberculoma–an enigmatic pituitary infection: a series of 18 cases.Clin Neurol Neurosurg. 2000; 102: 72-77
- Pituitary tuberculosis.J Assoc Physicians India. 2007; 55: 453-456
- Sellar tuberculoma (letter).J Neurol Neurosurg Psychiatry. 1992; 55: 629
- Pituitary tuberculosis: a case report.Ann Endocrinol (Paris). 2005; 66: 340-346
- Isolated intrasellar tuberculoma mimicking pituitary adenoma.J Clin Neurosci. 2007; 14: 477-481
- A pituitary tuberculoma.J Neurol Neurosurg Psychiatry. 1987; 50: 360-361
- Intracranial tuberculoma.J Pathol Bacteriol. 1933; 37: 461-471
- Craniocervical tuberculosis: protocol of surgical management.Neurosurgery. 2003; 52: 72-81
- Tuberculosis.in: Braunwald E. Fauci A. Kasper D. Hauser S. Longo D. Jameson J. Harrison’s Principles of Internal Medicine. McGraw Hill, New York2005: 953-966
- Intracranial tuberculoma: an increasing problem in Britain.J Neurol Neurosurg Psychiatry. 1975; 38: 194-201
- Two hundred and one cases of intracranial tuberculomas treated surgically.J Neurol Neurosurg Psychiatry. 1958; 21: 308-311
- Pathological analysis of intracranial space occupying lesions in 1000 cases including children.J Neurol Sci. 1968; 6: 575-582
- Suprasellar tuberculoma presenting with diabetes insipidus and hypothyroidism–a case report.Neurol India. 2000; 49: 314-316
- Intracranial tuberculoma.Neurol India. 1996; 34: 161-163
- Tuberculoma.in: Vinken P.J. Bruyn G.W. Handbook of Clinical Neurology. American Elsevier Publishing, New York1975: 413-426
- Intracranial tuberculoma: a case report and review of the literature.Neurology (NY). 1981; 31: 1133-1136
- Tuberculomas of the brain in Britain.J Postgrad Med. 1972; 48: 678-681
- Appearance of tuberculoma during the course of tuberculosis meningitis.J Neurol. 1984; 70: 231-269
Article info
Publication history
Accepted:
December 7,
2008
Received:
October 12,
2008
Identification
Copyright
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
