الفهرس 
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Abstract
F0urty patients with sellar and suprasellar mass lesi0ns were admitted and treated in the peri0d fr0m 12/2015 t0 9/2018.
The lesi0n in such area were anat0mically related t0 many crucial neural and vascular structures, where, inferi0rly the pituitary gland and stalk. The suprasellar cistern c0ntains the 0ptic nerve and chiasm, as well as the car0tid arteries and their branches. Superi0rly, the hyp0thalamus and p0steri0rly, the mid brain and cranial nerves III, IV, V and VI might be enc0untered as well as the basilar artery and its branches.
The m0st c0mm0n lesi0ns enc0untered in this series were pituitary aden0mas representing (42.5 %), f0ll0wed by crani0pharyngi0ma, representing (30.0%) 0f cases, meningi0ma representing (12.5%) 0f cases, gli0ma representing (7.5%) 0f cases, suprasellar abcess representing (2.5%) 0f cases, Rathke’s cleft cysts representing (2.5%) 0f cases, lymph0ma representing (2.5%) 0f cases .
The age and sex incidence differ acc0rding t0 the type 0f the lesi0n. The age at diagn0sis ranged bel0w 3 t0 79 years and the mean age f0r all cases was 31.5 years. 21 cases were males and 19 cases were females with prep0nderance 0f males 0ver females.
The main sympt0ms and signs were increased intracranial tensi0n f0ll0wed by visual sympt0ms and end0crinal disturbances.
Headache was the m0st c0mm0n c0mplaint (97.5%) f0ll0wed by blurring 0f visi0n (80.0%), dipl0pia and nausea & v0miting (75% ). Visual acuity affecti0n , visual field affecti0n and fundus affecti0n were the m0st c0mm0n signs. The m0st c0mm0n end0crinal abn0rmalities in the study were pr0lactin h0rm0ne elevati0n (galact0rrhea) and excess gr0wth h0rm0ne (acr0megaly). H0rm0nal assay was d0ne in all cases 0f pituitary aden0mas, all cases 0f crani0pharyngi0mas and s0me cases 0f meningi0mas . Epileptic fits was the presenting sympt0m in 14 cases ( 35.0 % ) . Behavi0ral changes was in 17 cases (42.5 %) .
C.T. with and with0ut c0ntrast enhancement was d0ne, Small size tum0rs, h0m0gen0us tum0rs, r0unded tum0rs were significantly m0st frequent in pituitary aden0ma f0ll0wed by meningi0ma and least frequent in crani0pharyngi0ma. Calcificati0ns were significantly m0st frequent in crani0pharyngi0ma f0ll0wed by meningi0ma and least frequent in pituitary aden0ma. Cystic changes and extensi0n t0 3rd ventricle were significantly m0st frequent in crani0pharyngi0ma f0ll0wed by pituitary aden0ma and least frequent in meningi0ma. Hydr0cephalus was significantly m0st frequent in crani0pharyngi0ma.
MRI was d0ne f0r all cases with T1W1, T2W1sequences and with c0ntrast, Small size tum0rs, h0m0gen0us tum0rs, r0unded tum0rs were significantly m0st frequent in pituitary aden0ma f0ll0wed by meningi0ma and least frequent in crani0pharyngi0ma. Calcificati0ns were significantly m0st frequent in crani0pharyngi0ma (83.3 %) f0ll0wed by meningi0ma and least frequent in pituitary aden0ma. Cystic changes and extensi0n t0 cavern0us sinus were significantly m0st frequent in crani0pharyngi0ma f0ll0wed by Meningi0ma and least frequent in Pituitary Aden0ma. Hydr0cephalus was significantly m0st frequent in crani0pharyngi0ma.
Magnetic res0nance angi0graphy was needed t0 determine displacement 0r engulfment 0f the car0tid artery bef0re surgical interventi0n, delineate the surr0unding vascular elements 0r t0 detect any ass0ciated vascular lesi0ns.
In this study, surgical pr0cedures in the f0rm 0f t0tal radical resecti0n, subt0tal excisi0n, partial excisi0n and bi0psy were d0ne in ne0plastic lesi0ns. C.S.F. diversi0n in the f0rm 0f ventricul0-perit0neal shunt had been d0ne in acute hydr0cephalus cases pre0peratively and p0st0peratively (35.0 %).
The ch0ice 0f surgical appr0ach was determined by the lesi0n site , the directi0n 0f gr0wth and the experience 0f the surge0n .
End0sc0pic transsphen0idal appr0ach was suitable f0r m0st pituitary aden0mas d0ne in 15 cases (88.2%),. Its main indicati0n in the study was sellar and suprasellar tum0rs mainly midline with limited lateral 0r p0steri0r extensi0n.
The pteri0nal appr0ach was utilized in 19 cases (47.5 %) 0f the cases, 4 cases 0f meningi0mas, 10 cases 0f crani0pharyngi0mas ,2 cases 0f pituitary aden0ma and the case 0f rathke`s cleft cyst . Its indicati0n was a supra-0r parasellar lesi0ns with b0th lateral and p0steri0r extensi0n specially th0se reaching the clivus.
The subfr0ntal appr0ach was ad0pted in 6 cases (15.0%) 0f the cases in the study, 2 cases 0f crani0pharyngi0mas, 1 case 0f meningi0ma and 3 cases 0f astr0cyt0ma. Its main indicati0n in the study was sellar and suprasellar tum0rs mainly midline with lateral 0r anteri0r extensi0n. In m0st cases a right crani0t0my was perf0rmed f0ll0wing tum0r exp0sure and visualizati0n the area 0f the visual apparatus.
Pteri0nal appr0ach was significantly m0st frequently used in Crani0pharyngi0ma f0ll0wed by Meningi0ma and least frequently used in pituitary aden0ma. T0tal excisi0n was m0st frequent in pituitary aden0ma f0ll0wed by meningi0ma and least frequent in crani0pharyngi0ma. Shunt was significantly m0st frequent in crani0pharyngi0ma. P0st0perative radi0therapy was significantly m0st frequent in pituitary aden0ma f0ll0wed by crani0pharyngi0ma and least frequent in meningi0ma.
Early p0st0perative neur0imaging sh0uld be d0ne t0 determine the extent 0f surgery f0r future treatment planning purp0ses and t0 evaluate the efficacy 0f the surgical pr0cedure and the presence 0f c0mplicati0ns.
The m0st c0mm0n p0st0perative c0mplicati0n was visual affecti0n. Diabetes insipidus was the m0st c0mm0n p0st0perative end0crinal disturbances. P0st 0perative epileptic fits happened in 22 cases ( 55.0 % )
The greatest incidence 0f seri0us c0mplicati0ns had been d0ne in t0tally excised tum0rs.
The 0utc0me in the study were 32.0% 0f patients had an excellent result, 44.0% 0f patients had a g00d result, 16.0% 0f patients had a m0derate result, 4.0% 0f patients had a p00r result and 4 cases died fr0m severe p0st0perative hyp0thalamic damage.