MAGNETIC RESONANCE IMAGING, BIOCHEMICAL AND SURGICAL CORRELATION OF THE INTRA-CYSTIC CONTENTS IN SELLAR TUMORS

Najla Z. Halabi-Almeida; Fernando R. Pimentel-Filho; Márcia Nery; Luiz R. Salgado; Jayme Goldman; Bernardo Liberman; Arthur Cukiert.

Departments of Endocrinology and Neurosurgery, Hospital Brigadeiro-São Paulo

RATIONALE

Sellar tumors frequently disclose solid and cystic components. The appearance of these cysts, as defined by MRI, can suggest the nature of the lesion. The hyperintensity found in many of these cysts by MRI had been attributed to their high content of protein, lipids or hemoglobin derivatives. This paper analyses the imaging, biochemical and surgical findings in cystic tumors of the sellar region.

METHODS

Seven patients with cystic tumors of the sellar region (3 macroadenomas; 4 craniopharingiomas) who underwent high resolution MRI pre-operatively were studied. All patients were operated by the transesphenoidal or transcranial approach and in all the cystic fluid was aspirated before tumor removal and its proteic and lipidic content analised.

RESULTS

The mean protein and lipid concentration in the macroadenomas were 7.1g /dl and 146.6 mg/dl, respectively. In the craniopharingiomas, these concentrations were 5.2 g/dl and 161 mg/dl, respectively. Within the macroadenomas, signal intensity correlated to the timing of previous hemorhage; in the craniopharingiomas, the hyperintensity correlated only to the presence of cholesterol cristals within the cystic fluid and not to the protein and lipid content

CONCLUSIONS

Contrary to what has been suggested by the few previous studies on the issue, our data suggest that the hyperintensity seen in craniopharingiomas is related to the presence of cholesterol crystals and not to the measured lipidic and proteic concentrations. The intraoperative findings are clearly well correlated to what was suggested preoperatively by MRI.