Recurrent intrasellar meningioma after total excision in a woman with hyperprolactinaemia

Intrasellar meningioma is a rare disease which is difficult to diagnose preoperatively. We describe an interesting case of intrasellar meningioma in a 39-year-old woman who presented with amenorrhea, galactorrhea and severe headaches for six months. An intrasellar mass was demonstrated by computed tomography. The mass was approached by the transcranial route, an intrasellar tumour was found pushing against the diaphragma sellae. After complete removal of the tumour, the patient was discharged with resolution of visual and endocrine abnormalities and normal serum prolactin level. Histopathological examination revealed meningioma. Within six months, the lesion reappeared with the same visual and endocrine abnormalities. Computed tomography revealed a contrast enhancing intrasellar lesion and serum prolactin level was again elevated. At reexploration, the tumour was excised. Pure subdiaphragmatic intrasellar meningiomas simulating prolactinomas are unusual lesions. Such early recurrences may be attributed to incomplete resection or to the histological character of the tumour. In spite of the rarity of intrasellar meningioma, preoperative differentiation from a pituitary adenoma is vital for the proper surgical approach