Suprasellar tumor. The study is very limited by artifact related to dental braces. The diffusion and gradient/SWI images are nondiagnostic.The patient did have a right frontal craniotomy and subfrontal approach to the mass. Small, heterogeneous collection overlying the right frontal lobe causes no significant mass effect.There is a large, lobulated, well-circumscribed suprasellar mass (separate from the pituitary gland). The mass measures in the coronal plane 3.7 cm x 3.3 cm. Anterior posteriorly, it measures 2.2 cm on the sagittal plane. The mass is heterogeneously T2 hyperintense and shows intense but heterogeneous contrast enhancement. The mass is heterogeneously T1-hypointense relative to gray matter with focus of intrinsic T1 shortening in the dependant part of the cystic component of the mass (which happen to be more intensely T2 bright as well and are new since the previous, preop MRI). These focus might be related to layering postbiopsy hemorrhage and measures axially 3 x 17 mm. The mass is associated with compression of the third ventricle and splaying of the thalami superiorly. There is also edema-like signal along the adjacent left optic tracts. It also stretches the optic chiasm from posteriorly. It laterally displaces without circumferentially encasing the supraclinoid internal carotid arteries as well as the A1 segments. It causes similar mass effect on the tip of the basilar artery and the P1 segments. Compared to the preoperative examination, the very anterior-inferior part of the mass has been resected. The remainder of the mass has not changed. Intracranial major vessels remain patent. There is incidental posterior left frontal developmental venous anomaly.The paranasal sinuses and the mastoid air cells remain clear.
1.Large suprasellar mass is most compatible with a craniopharyngioma. The mass has relationship to adjacent structures as described above.2.Since the examination of August 9, 2015, the mass has been partial resection as described above.3.Dependent, layering focal T1/T2 hyperintensity within the mass is new and may represent minimal intralesional hemorrhage.