Article

Sphenoid sinus pyocele after transsphenoidal approach for pituitary adenoma.

Department of Neurosurgery, International Neuroscience Institute, Rudolf-Pichlmayer-Straße. 4, 30625, Hannover, Germany.
Pituitary (impact factor: 1.83). 03/2011; 15(2):188-92. DOI:10.1007/s11102-011-0305-4 pp.188-92
Source: PubMed

ABSTRACT Transsphenoidal pituitary adenoma surgery is related to a low morbidity rate. The complications that can occur are classified as intra- and extracranial. The aim of the study is to discuss one group of these complications involving the sphenoid sinus: mucocele and its possible transformation into pyocele. We evaluate clinical presentation, management strategy and the outcome after long-term follow-up presenting an explicative case and a review of the literature. A patient presented to our outpatient clinic 8 months after transsphenoidal surgery for selective removal of a pituitary adenoma because of an acute onset of frontal headache during an airplane travel, fever and pulsating sensation in left eye and ear. MRI revealed a contrast-enhancing lesion in the left inferior portion of the sphenoid sinus. An endonasal endoscopic revision of the sphenoid sinus was performed. After opening of the scar to enter in the left sinus a pyocele was found and treated with drainage and marsupialisation. Development of sphenoid sinus pyocele is an extremely rare postoperative complication of transsphenoidal surgery. This lesion should be taken in consideration in patients presenting with retroorbital headache of acute onset and fever after pituitary surgery. Diagnosis can be suspected on the MRI studies and confirmed by a targeted flexible endoscope examination. Endoscopic drainage with wide opening of the sphenoid sinus and marsupialisation is the treatment of choice to avoid recurrences.

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Keywords

acute onset
 
endonasal endoscopic
 
Endoscopic drainage
 
explicative case
 
left inferior portion
 
low morbidity rate
 
MRI studies
 
outpatient clinic 8 months
 
patients
 
pituitary adenoma
 
pituitary surgery
 
possible transformation
 
pulsating sensation
 
rare postoperative complication
 
sphenoid sinus
 
sphenoid sinus pyocele
 
targeted flexible endoscope examination
 
Transsphenoidal pituitary adenoma surgery
 
transsphenoidal surgery
 
wide opening