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Fig 2. Selective bilateral internal carotid artery (ICA) angiograms. A, Early arterial lateral, (B) late arterial anteroposterior (AP), and (C) venous lateral magnified views of the left ICA injection. There are numerous vascular pedicles arising from the supraclinoid portion of the ICA that represent the various inferior and superior hypophyseal branches (arrows, A and B) that supply the neurohypophysis and hypothalamus. The meningohypophyseal trunk, which supplies the inferior hypophyseal artery as well as the dorsal meningeal artery, is also visible, arising from the posterior genu of the cavernous ICA (arrowheads). During the venous phase (C), the tumor stain is apparent, extending from the suprasellar region upwards in a "dumbbell" or "mushroom" pattern. There is a prominent portal vein draining into the dural venous sinus (arrow). D, Late venous phase of the lateral injection of the right ICA. The shape of the tumor stain is well seen with a caudad extension along the enlarged pituitary stalk and cephalad extension into the hypothalamus. The delayed tumor stain and prominence of the meningohypophyseal trunk at first glance suggest a meningioma of the diaphragma sella and suprasellar region.
