Presentation and Endoscopic Treatment of Cholesterol Granulomas in the Sellar and Suprasellar Regions: A Case Report

Although intracranial cholesterol granulomas are a rare occurrence, they have been reported in the petrous apex, brainstem, cerebellopontine angle, orbitofrontal, and temporal regions. We report the presentation and endoscopic treatment of two cases involving the sellar and suprasellar regions. The first patient was a 35-year-old African-American female presenting with headaches and central diabetes insipidus. Radiographic imaging confirmed a sellar mass with characteristics of a pituitary adenoma. Complete endoscopic transsphenoidal resection was performed without complications, the final pathology of which was consistent with a cholesterol granuloma. The second patient was a 30-year-old female with chronic headaches and acystic suprasellar mass, with radiographic characteristics of a craniopharyngioma. Similarly, resection with an endoscopic transsphenoidal approach was successful and histology was consistent with a cholesterol granuloma. The pathology description of either specimen showed a central cholesterol granuloma and surrounding tumor capsule with hemosiderin deposition. Although uncommon, cholesterol granulomas should be considered in the differential diagnosis of sellar and suprasellar lesions. In this case report, we describe our technique for a purely endoscopic approach to the resection of two sellar and suprasellar cholesterol granulomas. Furthermore, we discuss their clinical and radiographic characteristics and hypothesize the etiology of their occurrence at this location.