Parasellar Xanthogranulomas: A Case Report

Objective: Parasellar Xanthogranulomas are rare inflammatory masses often found in the skin and eye. Research on this lesion has not been reported in the English literature. The incidence of intracranial Xanthogranulomas is 1.6–7.0%, with those found in the sellar and parasellar region being exceedingly rare. We present our experience with these lesions and try to identify possible pre-operative signs suggestive of Xanthogranulomas.

Study Design: Retrospective chart review in a tertiary care center.

Subjects: Patients with histologically confirmed Xanthogranulomas, who were diagnosed and treated between 1990 and 2013, by the Weill Cornell endoscopic skull base team.

Methods: The endoscopic skull base database was analyzed for patients with Xanthogranulomas. Patient history, demographics, histology, and surgical approach were also evaluated.

Results: Four patients were identified as having a histologic Xanthogranuloma of the parasellar region. The most common symptoms were progressive loss of vision and headache. MRI findings included intracystic hemorrhagic or proteinaceous debris with the Rathke cyst and craniopharyngiomas commonly in the differential diagnosis. All lesions were resected via an extended endoscopic transsphenoidal, transplantum, and transtuberculum approach. Most common histologic findings include granulomatous inflammatory cell infiltration, hemosiderin-laden macrophages, cholesterol clefts, and giant cells. At last follow up, all patients had resolution of symptoms.

Conclusion: We reported on our experience with Xanthogranulomas of the Parasellar region. At this point, pre- operative evaluation does not clearly differentiate these lesions from other pituitary lesions. Based on our experience, we support gross total resection with the transsphenoidal approach to differentiate from more common lesions such as craniopharyngiomas ans Rathke cyst.