Clinicoradiologic Features and Surgical Outcomes of Sellar Xanthogranulomas: A Single-Center 10-Year Experience

Xanthogranulomas are uncommon granulomatous entities, and xanthogranulomas occurring in the sellar region are extremely rare, with a limited number of cases reported in the literature. Diagnosis, management, and prognosis of sellar xanthogranulomas are poorly understood.

We retrospectively reviewed 14 patients with histologically proven sellar xanthogranulomas treated at our institution between January 2006 and July 2016. Clinical manifestations, radiologic features, operative records, and follow-up outcomes were analyzed.

There were 9 male and 5 female patients with a mean age of 29.2 years. Clinical manifestations included headache (n = 12; 85.7%), visual deficiencies (n = 10; 71.4%), and endocrine disturbances (n = 6; 42.9%). On magnetic resonance imaging, sellar xanthogranulomas revealed isointensity to hyperintensity on T1-weighted imaging and hyperintensity or heterogeneous intensity on T2-weighted imaging with variable enhancement. Gross total resection of the lesion was achieved in 10 cases, and subtotal resection was achieved in 4 cases. Postoperatively, headache was relieved in all cases; transient diabetes insipidus was observed in 2 cases. There were no procedure-related complications. During a mean follow-up period of 52.9 months, visual deficiencies were improved in 7 (70.0%) cases, whereas endocrine disturbances were improved in only 2 (33.3%) cases. No recurrence or regrowth of the residual lesions was observed.

Sellar xanthogranuloma should be considered in the differential diagnosis of lesions in the sellar region. Some radiologic characteristics, including hyperintensity on T1-weighted imaging, heterogeneous hyperintensity on T2-weighted imaging, variable enhancement, and absence of calcification, can assist in making the preoperative diagnosis. Surgical outcomes are favorable.