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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Intrasellar abscess following pituitary surgery
Kevin T Huang1, Wenya Linda Bi, Timothy R Smith
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA, 02115, USA.
Pituitary
|March 28, 2015
Summary
Intrasellar abscesses, rare infections of the pituitary gland, are often linked to recent surgery. Prompt surgical drainage and antibiotics can lead to favorable outcomes for patients with pituitary abscess.
Area of Science:
- Neurosurgery
- Endocrinology
- Infectious Diseases
Background:
- Intrasellar abscesses are rare mass lesions in the sella turcica.
- Etiology and diagnosis of intrasellar abscesses are not well understood.
- Few cases have been reported in medical literature.
Purpose of the Study:
- Review a series of patients with intrasellar abscess.
- Identify defining characteristics of presentation and management.
- Understand the etiology and diagnosis of intrasellar abscesses.
Main Methods:
- Retrospective chart review of intrasellar infection cases with mass lesions.
- Inclusion criteria: imaging demonstration of mass lesion and positive microbiological cultures.
- Examination of clinical presentation, management, post-operative course, neuroimaging, microbiology, and pituitary biochemical markers.
Main Results:
- All patients had recent transsphenoidal pituitary surgery (within 10 months).
- Common presentations included headaches, visual loss, meningismus, and fever, sometimes with cerebrospinal fluid leak.
- No acute endocrine abnormalities were observed; MRI findings varied, but diffusion restriction was noted in one case over time. Favorable outcomes were achieved with treatment.
Conclusions:
- Pituitary abscess is a rare and difficult diagnosis.
- A strong association exists between culture-positive abscess and recent pituitary surgery.
- Prompt surgical drainage and aggressive post-operative antibiotics are crucial for favorable outcomes.
