Female 58 years old with Hx of R-ear hearing loss, bifrontal headaches worse when lying supine, periods of sweating and blurred vision, evaluate for structural abnormality. There is a lobulated suprasellar mass, measuring 15 mm craniocaudal x 10 mm transverse x 13 mm anteroposterior dimension, which enhances homogeneously and is situated along the right optic tract/chiasm. It appears to have a dural attachment along the posterior planum sphenoidale and projects into the suprasellar cistern with impingement on the right optic nerve and chiasm, displacing it posteriorly. Although it enhances similarly to the pituitary gland, it appears separate from the gland itself and is extra-sellar in origin. Although these are not dedicated pituitary images, the pituitary gland appears to be normal in morphology.No evidence of other enhancing intracranial lesions, hemorrhage, or restricted diffusion to suggest acute infarct. There are a few nonenhancing focal periventricular T2/FLAIR hyperintense lesions, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Lobulated dural based extra-axial mass situated along the planum sphenoidale just anterior and superior to the sella with no definite sellar involvement. The lesion impinges on the right optic nerve and chiasm. The pituitary gland itself appears unremarkable. The differential includes a meningeal-based tumor such as a meningioma or hemangiopericytoma. Additional considerations include germinoma and craniopharyngioma.