 There is heterogeneously enhancing tissue within the sella measuring 25 x 11 x 9 mm with a convex upper border mildly encroaching upon the suprasellar cistern without significant mass-effect on the optic chiasm. Additionally, there is a 7 x 7 mm focus of nodular enhancement adjacent to the sella along the left dorsum sella/petroclival ligament. The cavernous sinuses enhance symmetrically without thickening.There is no suspicious enhancement or mass along the cranial nerves 7/8 complexes. The inner ear structures are within normal limits. There is no suspicious intracranial enhancement elsewhere. There is no acute infarct, mass effect or midline shift. There are mild periventricular and subcortical white matter T2 signal abnormalities likely representing chronic microvascular ischemic changes. The extracranial soft tissues and calvarium are within normal limits.
1.Mass like process in the sella with an additional small nodular enhancing lesion along the left dorsum sella/petroclival ligament. It is conceivable that these two lesions reflect distinct processes such as a macroadenoma/sequela of prior pituitary injury, and a separate small petroclival meningioma. Alternatively, a single unifying diagnosis of either a macroadenoma spreading along the dorsum sella/petroclival ligament, or an sellar meningioma extending along the left petroclival ligament would be possible. An atypical inflammatory or granulomatous etiology could also be considered. Regardless, these findings would not explain the patient's left unilateral peripheral vestibular weakness and asymmetric sensorineural hearing loss, and they may therefore be incidental.2.Unremarkable exam of the IACs.3.Mild chronic microvascular ischemic changes.