Partially Thrombosed Aneurysm of Persistent Trigeminal Artery

Findings:

A rounded mixed signal structure is present within the sella which demonstrates some peripheral hyperintensities due to sluggish internal flow on the MRA source images and is predominantly low signal on T2. The rounded structure is contiguous with a large vessel connecting the basilar artery directly to the right cavernous ICA.

Discussion:

Mixed signal rounded sellar lesions with heterogenous T2 hypointensity and T1 hyperintensity have a broad differential diagnosis, but aneurysm should always be excluded first if there is any consideration for surgical intervention. If not confirmed to arise from an arterial structure, a large Rathke's cleft cyst, hemorrhagic pituitary adenome, or intrasellar craniopharyngioma could be considered.

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