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Updated: May 8, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Invasive sphenocavernous aspergilloma complicating an operated case of acromegaly
Sunil V Furtado1, Prasanna K Venkatesh, Nandita Ghosal
1Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Karnataka State, Bangalore, India.
Abstract:
There is a surge in fungal infections of the central nervous system due to an increase in the incidence of immunocompromised state and widespread use of antimicrobials. Despite myriad clinical presentations and skull base syndromes associated with Aspergillus infections, aspergilloma in the sella is relatively rare. We report a rare case of aspergilloma of the sella and parasellar region in a patient operated for acromegaly. A 30-year-old diabetic patient underwent two surgeries for a growth hormone-secreting pituitary adenoma, which included a transsphenoidal approach. During his last admission, magnetic resonance imaging revealed a heterogeneous mass in the sella, suprasellar region, sphenoid sinus, and cavernous sinus with multiple areas of necrosis. His presentation, surgical treatment, and response to antifungal therapy are discussed. The role of prior surgery and related comorbidities in developing the invasive granuloma are highlighted.
Insights
Central nervous system fungal infections are rising, particularly rare sellar aspergilloma. This case highlights invasive fungal granuloma development after pituitary surgery in an immunocompromised patient.
Area of Science:
- Neuroscience
- Mycology
- Endocrinology
Background:
- Central nervous system (CNS) fungal infections are increasing, linked to immunocompromised states and antimicrobial use.
- Aspergillus infections, while varied, rarely present as aspergilloma in the sella turcica.
- Pituitary adenomas and prior surgeries can be risk factors for complex infections.
Purpose of the Study:
- To report a rare case of aspergilloma in the sella and parasellar region.
- To discuss the clinical presentation, surgical management, and antifungal treatment of this rare condition.
- To explore the role of prior surgery and comorbidities in the development of invasive fungal granuloma.
Main Methods:
- Case report of a 30-year-old diabetic patient with a history of acromegaly surgery.
- Magnetic resonance imaging (MRI) to characterize the sellar and parasellar mass.
- Surgical intervention and subsequent antifungal therapy.
Main Results:
- A heterogeneous mass involving the sella, suprasellar region, sphenoid, and cavernous sinuses with necrosis was identified.
- The patient underwent surgical treatment and responded to antifungal therapy.
- Prior surgeries for pituitary adenoma and diabetes were considered contributing factors.
Conclusions:
- Aspergilloma of the sella and parasellar region is a rare but significant complication, especially in patients with a history of pituitary surgery and comorbidities.
- Multidisciplinary management involving neurosurgery, infectious disease, and endocrinology is crucial.
- Early diagnosis and appropriate antifungal treatment are essential for favorable outcomes.
