Introduction: Teratomas are midline tumors commonly diagnosed during childhood and treated as soon as they are diagnosed. We present a giant suprasellar case with an unusual retroclival extension operated in adulthood after several years of follow-up.

Case report: A 36-year-old male, diagnosed during childhood of an intracranial teratoma without any specific treatment, came to our hospital complaining of uncontrollable headache and vomiting after more than 30 years being asymptomatic. Neurorradiological investigations revealed tumor growth with giant solid and cystic suprasellar mass and significant extension to retroclival area until foramen magnum. Due to this clinical and new imaging findings we decided to underwent a definitive treatment. Results: A retrosigmoid approach was performed and subtotal resection was achieved. Our patient experienced immediate clinical relief and no postoperative complications except a temporary third nerve palsy. He was discharged at home a week later with definitive diagnosis of mature teratoma. A week later, a definitive ventriculoperitoneal shunt was placed due to secondary hydrocephalus.

Discussion: Teratomas constitute a major birth neoplasms, the most common (1/35,000-40,000 live births), they are always more common in men and in midline, primarily in pineal region, suprasellar, basal ganglia and thalamus. We report long-term clinical behaviour for mature teratoma with an unusual location and treated in an adult patient after several years of follow-up.