There are four possible causes of suprasellar masses: malignant growths, abnormal blood vessel development, congenital development, and infectious inflammation. Different neurologic or endocrine problems are mostly caused by suprasellar masses, based on where they start and how they affect nearby systems.
Between the hypothalamus and the pituitary, there is a gap called the suprasellar cistern, which is filled with cerebrospinal fluid. The pituitary stalk generally enters the pituitary gland through this gap, which is vital to the gland’s regular function.
Hypopituitarism is a group of conditions that arise if the pituitary stalk is damaged. These conditions include diabetes insipidus, hypoadrenalism, hypogonadism, hypothyroidism, and a lack of growth hormone. Because of its proximity to the hypothalamus, the endocrine system is often profoundly affected by any mass lesion in the suprasellar cistern. It is also possible to compress the optic chiasm, which mostly results in a reduction in peripheral vision.
Suprasellar Mass Location
A suprasellar meningioma develops toward the back of the brain, close to the optic nerve and the pituitary gland. Visual impairments and pituitary gland dysfunction are two symptoms associated with tumors in this region. Meningiomas of any type can develop into recurrent tumors over time. These tumors can induce pituitary hormone malfunction and expand over months or years.
About 10% of all meningiomas are suprasellar meningiomas, which typically afflict middle-aged women and men and develop close to the pituitary and optic nerves at the base of the skull. If these slow-growing tumors strain on the optic nerves, significant vision loss occurs in one or both eyes.
Suprasellar Mass Symptoms
The suprasellar region includes the optic nerves, the pituitary stalk, optic chiasm, and the Willis circle. It begins just above the sellar diaphragm and continues down to the bottom of the third ventricle. It is situated near the mammillary bodies, the tuber cinereum, the hypothalamus, and the third ventricle.
For a few months to a few years, these tumors develop and eventually lead to hormone imbalance in the Pituitary gland.
Some other symptoms of this disease are:
- Alterations in behavior.
- Numbness of the face.
- Loss of smell.
Suprasellar Mass Causes
Pituitary adenomas predominately induce sellar area tumors in large retrospective series, followed by meningiomas, metastases, chordomas, cystic nonneoplastic lesions, and inflammatory lesions. Suprasellar masses are often caused by tumors, blood vessels, birth defects, or infections that cause inflammation. The preferred method for assessing suprasellar masses is magnetic resonance imaging (MRI), while computed tomography (CT) also offers additional data.
Suprasellar Mass Treatment
Depending on the position and tumor size, the patient’s unique requirements, and the findings of imaging tests, surgeons design individualised treatment plans. The surgeons usually totally remove the tumor if the patients are displaying symptoms (surgical resection). Doctors employ either an open craniotomy or a minimally invasive endoscopic treatment conducted through the nose, depending on the patient’s specific situation. If the tumor is in or near the pituitary region, it is recommended that the patient contact a neuroendocrinologist to ensure correct pituitary care and management.
After the procedure, the patient is advised to spend one or two nights in the hospital, and they are allowed to leave the hospital within two or five days later. Even on the day following surgery, the doctors advise the patients to get moving with the help of the physical therapists.
It is crucial to refrain from blowing the nose following surgery if it is done transnasally (through the nose). The nasal packing is planned to remain in place for roughly one week.
If the neurosurgeon gives the go-ahead, doctors encourage the patient to stand and walk immediately after the procedure. Heavy lifting is not recommended. Acute rehabilitative therapy is typically not necessary following surgery for patients with suprasellar meningiomas. Following discharge, most patients return to their doctors for a follow-up session.