47 years, Male, brain tumor, preoperative planning with individuals. Examination is limited to sequences for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen is an expansile mass centered at the sella measuring approximately 5.4 x 5.5 cm in the AP and transverse dimensions and approximately 7.8 cm in the craniocaudal dimension. Mass is almost entirely solid with a cystic component more superiorly.Mass fills the suprasellar cistern and extends posteriorly into the right perimesencephalic cistern with mild mass effect on the right cerebral peduncles. Noted is lateral extension into the bilateral cavernous sinuses. There is encasement and superior displacement of the optic chiasm and prechiasmatic optic nerves. Noted is intracranial extension involving the left inferior frontal lobe and anterior basal ganglia. Also noted is surrounding vasogenic edema in the left frontal lobe. There is mass effect with rightward subfalcine herniation as before. Anteriorly mass involves the clivus and sphenoid sinus.Tumor abuts the right posterior cerebral artery. The distal ICA, bilaterally A1 segments, and left M1 segments are also intimately associated with the tumor. The distal ACAs are rightward displaced. There is mild entrapment of the right lateral ventricle. Remainder of the brain appears unremarkable without additional lesions.
Examination for surgical planning. Large mass most favored to represent a pituitary macroadenoma with invasive features, peritumoral cyst, and intracranial mass effect as detailed above. Craniopharyngioma is less likely but remains a possibility. 