Epidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report.
BACKGROUND
Epidermoids of the central nervous system are rare tumors. They are usually found in the fourth decade of life and most commonly off midline in the cerebellopontine angle. We report here a rare case of an epidermoid arising from the sphenoid sinus with extension into the sella and adjacent structures with acute onset of neurological deficit. The significance of the clinical presentation resembling pituitary apoplexy and magnetic resonance imaging (MRI) findings is noted.


METHODS
A 25-year-old man presented with acute severe headache, diplopia, and decreased visual acuity. Examination revealed right-sided ptosis and paresis of the third cranial nerve on the right side. Computed tomography and MRI were suggestive of a slow-growing sphenoid sinus mass with extension into the sella. The sublabial transsphenoidal approach was used to remove the mass under direct visualization. The patient's neurological status improved to baseline both subjectively and objectively after the operation.


CONCLUSIONS
Epidermoids, although rare, should be considered as part of the differential diagnosis when evaluating lesions of sphenoid sinus or sellar origin.
Sani
Sepehr
S
Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA. sepehr_sani@rush.edu
Smith
Adam
A
Leppla
David C
DC
Ilangovan
Saroja
S
Glick
Roberta
R
D000208:Acute Disease; D000328:Adult; D004172:Diplopia / Q000209:etiology; D004814:Epidermal Cyst / Q000150:complications* / Q000601:surgery*; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000601:surgery*; D010899:Pituitary Apoplexy / Q000209:etiology*; D013101:Sphenoid Sinus / Q000473:pathology*; D016896:Treatment Outcome