Commentary

Yilmazlar et al report a patient with a brown tumor in the sellar and parasellar region related to primary hyperparathyroidism. Concomitant progressive visual deficits and oculoparesis were detected at presentation. Their treatment management included aggressive surgical decompression and resection of the offending lesion, with pathological confirmation of the brown tumor. This patient’s short- and intermediate-term outcome was good, with resolution of visual deficits at 9 months. Although surgical decompression is a reasonable option when neurological symptoms are progressing, so too is simple biopsy of the tumor with surgical resection of the parathyroid adenoma. The rationale for biopsy is to confirm the pathological diagnosis because other lesions can mimic the appearance of brown tumors, as reviewed by Al-Gahtany et al.[1] In this case, we agree with the authors’ strategy, particularly because the patient’s vision was affected significantly. Because these lesions are so rare, their optimal treatment paradigm is unknown. Nonetheless, it is important for surgeons to be aware of both options for the treatment of brown tumors of the skull base.

REFERENCES

• 1 Al-Gahtany M, Cusimano M, Singer W et al.. Brown tumors of the skull base. Case report and review of the literature.  J Neurosurg. 2003;  98 417-420