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

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 structure...

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Bibliographic Details
Published in:Surgical neurology 2005-04, Vol.63 (4), p.394-397
Main Authors: Sani, Sepehr, Smith, Adam, Leppla, David C., Ilangovan, Saroja, Glick, Roberta
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Biological and medical sciences
Diplopia - etiology
Epidermal Cyst - complications
Epidermal Cyst - surgery
Epidermoid
Headache - etiology
Humans
Magnetic Resonance Imaging
Male
Medical sciences
Neurosurgery
Paranasal Sinus Diseases - complications
Paranasal Sinus Diseases - surgery
Pituitary Apoplexy - etiology
Sella turcica
Skull base
Sphenoid sinus
Sphenoid Sinus - pathology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
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Summary: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. 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. Epidermoids, although rare, should be considered as part of the differential diagnosis when evaluating lesions of sphenoid sinus or sellar origin.
ISSN:0090-3019
1879-3339
DOI:10.1016/j.surneu.2004.02.039