• T Beems, J A Grotenhuis, and P Wesseling.
• Department of Neurosurgery, Neurosurgical Centre Nijmegen, University Hospital St. Radboud, The Netherlands.
• Neurosurgery. 1999 Dec 1; 45 (6): 1474-7.

Objective And ImportanceTumors in the suprasellar region such as adenomas of the pituitary gland, craniopharyngiomas, nonneoplastic cystic lesions (especially Rathke's cleft cysts), and meningiomas are frequently encountered in neurosurgical practice. Meningiomas originate from the arachnoid layer connected to the dura of the anterior or posterior clinoidal process, or the tuberculum, dorsum, or diaphragma sellae. Tumors originating from the pituitary stalk are rare. Such lesions may include germinomas, astrocytomas, histiocytosis X, hamartomas, and sarcoidosis. We report a patient with a suprasellar meningioma originating from the pituitary stalk with no connection to the adjacent dura.Clinical PresentationA 50-year-old man was assessed for impotence and loss of libido. Physical examination revealed no abnormalities. Endocrinological investigations disclosed nearly complete hypopituitarism, and magnetic resonance imaging revealed a suprasellar homogeneously enhancing tumor.InterventionComplete surgical resection was performed in an endoscope-assisted right-sided supraorbital craniotomy. The tumor originated from the pituitary stalk with no connection to the surrounding dura. The histopathological diagnosis was meningioma.ConclusionAlthough meningiomas frequently occur in the suprasellar region, this patient with a suprasellar meningioma is unique because the tumor originated from the pituitary stalk with no connection to the surrounding dura. The absence of dural attachment has been described in 43 extracerebral meningiomas, but a suprasellar location has been reported only once previously. Recognition of this phenomenon is important, because meningiomas require a different therapeutic strategy than most other tumors of the pituitary stalk.

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