Paraganglioma of the pituitary fossa: diagnosis and management

Paraganglioma of the sellar area is extremely rare with only six cases havi ng been reported in the literature. Surgical removal of these tumors is dif ficult, and the transsphenoidal approach usually results in limited resecti on. Most authors who published reports on this tumor recommended radiation therapy after partial removal of the tumor. However, considering the benign nature of these tumors, the risk of radiation-induced endocrine insufficie ncy and optic neuropathy and the lack of proven effectiveness of radiothera py, its value remains controversial. We describe a 48-year-old woman with parasellar paraganglioma who presented with headaches, visual loss and oligomenorrhea. Magnetic resonance imaging (MRI) showed an invasive tumor in the sellar and parasellar areas which ex tended to both cavernous sinuses and compressed the optic chiasm and the le ft internal carotid artery. Surgery by the transsphenoidal approach enabled only limited biopsy of the tumor. The patient was reoperated by an extende d pterional approach which resulted in a subtotal removal of the tumor and adequate decompression of the adjacent structures. She received no adjuvant treatment during the 8-year postsurgical follow-up and remained in good he alth. A repeated MRI showed no change in the size of the residual tumor. Co ntrary to the therapeutic recommendations described in previous reports, we favor postoperative adjuvant therapy only if the symptoms or signs of cran ial nerve compression persist following maximal tumor removal, or if there is evidence of subsequent growth of residual tumor.