coronal MR images document invasion of the cavernous sinus by the macroadenoma and a tumor sleeve extending around the carotid artery (arrow).
chordomas of the clivus (Fig. 11.34b) or epidermoids (Fig. 11.34c) can also lead to compressive symptoms in the perisellar area.
Giant aneurysm: A giant aneurysm can originate anywhere in the circle of Willis and extend cranially, occasionally causing a compression of sellar and/or perisellar components (Fig. 11.35).
"Empty sella": The term "empty sella" designates a CSF-filled herniation of the meninges into the sella (Fig. 11.36) that can compress, for example, the pituitary gland. A similar situation (and image appearance) may of course develop after sellar surgery.
• Diagnosis: Paul puts two and two together. Mrs. Nuremberg is young and denies any endocrine symptoms. The lesion is primarily cystic and sits in the right location: this should be a craniopharyngioma. Paul is right. The visual field defect is associated with this tumor and its particular location characteristically is a bitemporal hemianopia. In
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