PDF(Pubmed)
Abstract：
BACKGROUND: Suprasellar masses commonly include craniopharyngiomas and pituitary adenomas. Suprasellar glioblastoma is exceedingly rare with only a few prior case reports in the literature. Suprasellar glioblastoma can mimic craniopharyngioma or other more common suprasellar etiologies preoperatively.
METHODS: A 65-year-old male with no significant history presented to the emergency department with a subacute decline in mental status. Work-up revealed a large suprasellar mass with extension to the right inferior medial frontal lobe and right lateral ventricle, associated with significant vasogenic edema. The patient underwent an interhemispheric transcallosal approach subtotal resection of the interventricular portion of the mass. Pathological analysis revealed glioblastoma, MGMT partially methylated, with a BRAF V600E mutation.
CONCLUSIONS: Malignant glioblastomas can mimic benign suprasellar masses and should remain on the differential for a diverse set of brain masses with a broad range of radiological and clinical features. For complex cases accessible from the ventricle where the pituitary complex cannot be confidently preserved via a transsphenoidal approach, an interhemispheric approach is also a practical initial surgical option. In addition to providing diagnostic value, molecular profiling may also reveal therapeutically significant gene alterations such as BRAF mutations.
METHODS: A 65-year-old male with no significant history presented to the emergency department with a subacute decline in mental status. Work-up revealed a large suprasellar mass with extension to the right inferior medial frontal lobe and right lateral ventricle, associated with significant vasogenic edema. The patient underwent an interhemispheric transcallosal approach subtotal resection of the interventricular portion of the mass. Pathological analysis revealed glioblastoma, MGMT partially methylated, with a BRAF V600E mutation.
CONCLUSIONS: Malignant glioblastomas can mimic benign suprasellar masses and should remain on the differential for a diverse set of brain masses with a broad range of radiological and clinical features. For complex cases accessible from the ventricle where the pituitary complex cannot be confidently preserved via a transsphenoidal approach, an interhemispheric approach is also a practical initial surgical option. In addition to providing diagnostic value, molecular profiling may also reveal therapeutically significant gene alterations such as BRAF mutations.
摘要：
背景：鞍上肿块通常包括颅咽管瘤和垂体腺瘤。鞍上胶质母细胞瘤极为罕见，文献中只有少数病例报道。鞍上胶质母细胞瘤可在术前模仿颅咽管瘤或其他更常见的鞍上病因。
方法：一名无明显病史的65岁男性因亚急性精神状态下降而就诊于急诊科。检查发现一个大的鞍上肿块，并延伸到右下内侧额叶和右侧脑室，伴有明显的血管源性水肿。患者接受了半球间的经call体入路，对肿块的室间部分进行了次全切除。病理分析显示胶质母细胞瘤，MGMT部分甲基化，BRAFV600E突变。
结论：恶性成胶质细胞瘤可以模拟良性鞍上肿块，并且对于具有广泛放射学和临床特征的各种脑肿块应保持差异。对于从脑室进入的复杂病例，垂体复合体无法通过经蝶入路可靠地保留，半球间方法也是一种实用的初始手术选择。除了提供诊断价值外，分子谱分析也可能揭示治疗上显著的基因改变,如BRAF突变.
方法：一名无明显病史的65岁男性因亚急性精神状态下降而就诊于急诊科。检查发现一个大的鞍上肿块，并延伸到右下内侧额叶和右侧脑室，伴有明显的血管源性水肿。患者接受了半球间的经call体入路，对肿块的室间部分进行了次全切除。病理分析显示胶质母细胞瘤，MGMT部分甲基化，BRAFV600E突变。
结论：恶性成胶质细胞瘤可以模拟良性鞍上肿块，并且对于具有广泛放射学和临床特征的各种脑肿块应保持差异。对于从脑室进入的复杂病例，垂体复合体无法通过经蝶入路可靠地保留，半球间方法也是一种实用的初始手术选择。除了提供诊断价值外，分子谱分析也可能揭示治疗上显著的基因改变,如BRAF突变.
