A LARGE SUPRASELLAR PSAMMOMATOUS MENINGIOMA WITH BEAK OF A KIWI BIRD ENHANCEMENT: A CASE REPORT OF A RARE VARIANT

Abstract

The suprasellar meningioma (SSM) is definded as a tumor, which originating from tuberculum sella, diaphragma sella, spnenum plenoidale or anterior clinoid processes, and, developing between the two optic nerves, displacing the chiasm backwards and upwards. SSM represents 5-10% of all intracranial meningiomas. The classic syndrome consists of a bitemporal visual field defects and a normal sella in an otherwise healthy middle-aged person. We report a case of SSM in a 43 years old female, suffering from headache and progressive visual deterioration for about three months.Magnetic resonance (MR) imaging revealed a homogeneously enhancing suprasellar lesion with a characteristic beak of a Kiwi bird enhancement along the sphenum plenoidale as a dural tail. She underwent surgical treatment via unilateral pterional approach, achieving complete tumoral resection. Histopathological evaluation revealed WHO grade 1 psammomatous meningioma which is a rare varient for intracranial meningiomas. There was no neurological deficit after surgery. The radiological imaging generally differentiates  these tumors from other suprasellar tumors with a high degree of accuracy. The classical MR imaging finding is a homogeneously enhancing suprasellar mass with the characteristic anterior dural enhancement along the planum sphenoidale which resembles the beak of a Kiwi bird. Our case was confirmed histopathologically as a meningioma of psammomatous subtype which is the rarely seen varient in the intracranial region and the most common subtype in the spinal cord.