Suprasellar Mature Cystic Teratoma: An Unusual Location for an Uncommon Tumor

Intracranial germ cell tumors are uncommon and account for only 0.3–3.4% of all intracranial tumors. Teratomas are a subset of these neoplasms, and their finding in brain structures is exceptionally rare, and occurrence within the skull base is quite novel. The authors report the case of a 57-year-old male patient who presented with vision changes, incontinence, ataxia, and altered mental status of 1 week’s duration. Imaging revealed a large intrasellar mass with suprasellar extension, involvement of the ventricular system, and marked hydrocephalus with the enlargement of the lateral and third ventricles. The patient underwent a pterional craniotomy/transsylvian approach for resection of the mass. Postoperative histological examination of the resected mass was confirmatory for a mature cystic teratoma. This was followed by radiotherapy, stereotactic radiosurgery, and adjuvant radiotherapy. At the most recent followup, approximately 4 years later, the patient is doing well with improved vision since the operation. This report highlights our experience with a teratoma in a very unusual location, and we review the relevant literature. 1. Introduction Intracranial germ cell tumors of the central nervous system are rare and usually occur in the midline of the brain, particularly at the pineal region and neurohypophysis [1, 2]. While mixed forms are common, multiple types have been described with varying malignant behavior. Specifically, teratomas have been designated as benign tumors that contain representative components of all three germinal layers [3]. Teratomas comprise only 0.5% of all intracranial tumors [3]. One study found the age range for central nervous teratomas to be from 16 to 45 years, with the mean age being 15.9 years [4]. Common presenting symptoms of intracranial teratomas may include signs of raised intracranial pressure, visual disturbance, polydipsia, and polyuria [2, 4]. Treatment protocols for malignant intracranial mature nongerminomatous germ cell tumor in adults have been adapted from strategies used in the pediatric population [5]. When imaging studies and CSF analysis are inconclusive, stereotactic or incisional biopsies provide a diagnosis by providing a histopathological sample [5]. Gross total resection may confer a survival benefit and prevent the development of more serious clinical complications [5], with the intracranial location of the tumor deciding the surgical approach [4]. We report on a rare case of a skull-base teratoma with suprasellar extension. 2. Case Presentation 2.1. History The patient is a 57-year-old man