HS, a 46-year-old male presented with decreased vision in his left eye along with impotence and diminished energy levels of about 3 months duration. His endocrine evaluation revealed pan-hypopituitarism. He was diagnosed with a suprasellar mass, mixed solid-cystic [Figure and ] and underwent an image-guided stereotactic (using skull fiducials) brain biopsy and aspiration of the cyst, which contained about 4 cc of oily fluid. Histologic review revealed a papillary CP. One month later he underwent Gamma Knife radiosurgery on the residual tumor []. Postoperatively he did well with a gradual improvement in his vision and a decrease in tumor size as seen on imaging 5 years following initial treatment [Figure and ]. His pan-hypopituitarism remained stable and he is currently being managed with hormone replacement therapy. Six years following Gamma Knife stereotactic radiosurgery (GKRS) treatment, his tumor recurred and he underwent an extended transphenoidal surgery presently remaining free of radiographic tumor.
MC, a 69-year-old female who following a head injury, was diagnosed with an incidental suprasellar cystic-solid mass. She remained asymptomatic for 4 years, subsequently developing diminished vision along with weight gain with an increase in lesion size. She underwent biopsy-aspiration of the cyst followed by Gamma Knife radiosurgery a month later. Subsequently 4 months later she developed a cyst recurrence on imaging and underwent Ommaya reservoir insertion, having no associated clinical changes. On follow-up, her MRI revealed an increase in the size of the cyst. Although further aspiration of the cystic component via the Ommaya reservoir was advised, she declined any intervention. Repeat imaging revealed a spontaneous decrease in the size of the cystic component that remained stable over time and required no further intervention.