Sellar Xanthogranuloma: Presentation, Management, and Surgical Outcome

Background: Sellar xanthogranulomas are extremely rare intracranial lesions comprising <1% of all sellar lesions and it is considered to be chronic inflammatory lesion resulting from infarction, hemorrhage, inflammation, and necrosis of pituitary adenoma, Rathke’s cleft cyst or craniopharyngioma. Because of sellar xanthogranuloma cases are rarely reported in the literature, they remain a diagnostic challenge with indefinite origin, clinical course, and outcome.

Study Design and Methods: This is a retrospective study conducted in large medical city. We included all the patients diagnosed with sellar xanthogranulomas during a period of 22 years (January 2000 to December 2022). Demographic data, clinical presentations, imaging findings, and clinical outcomes were collected.

Results: Five patients met the criteria and included in our study. Four patients had pathological confirmation of the finding, and one refused surgery and remained on radiological follow-up. The mean follow-up period was 19 months. Headache was the most common complaint reported by all patients, followed by visual and endocrine abnormalities in four patients. Of these four patients, all had decreased visual acuity and three had bilateral visual field defects. The radiological finding seen in all patient were high signal intensity on both T1- and T2-weighted sequences, and either entirely cystic or had a cystic component. All four patients who had visual complain at the time of diagnosed and underwent surgery had improvement on follow-up. Postoperatively, three patient who underwent surgery required hormonal replacement. No recurrence or progression (for the patient refused surgery) was seen in follow-up radiological imaging.

Conclusions: Sellar xanthogranulomas remain rare sellar lesions with few cases reported in the literature. Patients mostly present with headache, hypopituitarism and visual dysfunction. Surgery remains the best option to restored vision to all cases; however, three of our patients required long-term hormonal replacement.

Publication History

Article published online:
05 February 2024