Sellar and parasellar metastatic tumors

Area of Science:

• Neuro-oncology
• Endocrinology
• Ophthalmology

Background:

• The sellar and parasellar (SPS) region contains critical neurovascular structures.
• Metastases to the SPS region are rare but can be the initial sign of systemic malignancy.
• Breast cancer is the most frequent source of SPS metastases.

Purpose of the Study:

• To review the literature on sellar and parasellar metastases.
• To present six illustrative cases from the authors' institution.
• To discuss diagnostic and management challenges.

Main Methods:

• Literature review of SPS metastases.
• Case series of six patients with SPS metastases.
• Analysis of clinical and radiological features.
• Review of treatment modalities including surgery, radiation, and chemotherapy.

Main Results:

• Common symptoms include ophthalmoplegia, headache, retroorbital/facial pain, diabetes insipidus, and visual field defects.
• Differentiating SPS metastases from other lesions is difficult due to nonspecific clinical and radiological findings.
• Multimodality therapy is the current standard of care.
• Surgical resection may not significantly improve survival but can enhance quality of life.

Conclusions:

• SPS metastases, particularly from breast cancer, require a high index of suspicion.
• Accurate diagnosis is often challenging, necessitating a comprehensive evaluation.
• A multimodality treatment approach, including palliative surgery, is recommended to manage symptoms and improve patient quality of life.