Suprasellar Tension Pneumatocele after Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma

Tension pneumatocele is a very rare but potentially fatal complication of transsphenoidal surgery that can result from an influx of air into the intracranial cavity through the cerebrospinal fluid fistula. Although transsphenoidal surgeries for pituitary adenomas are very commonly performed procedures, this complication is extremely rare. We report a case of tension pneumatocele after transsphenoidal resection of a pituitary macroadenoma. After a second endoscopic transsphenoidal procedure to remove the air and repair of the sella floor, visual acuity recovered dramatically. Tension pneumatocele is an uncommon but potentially lethal complication of transsphenoidal pituitary surgery, which can present anytime, even after years postoperatively. It is important for all skull base surgeons to be aware of this condition so that prompt treatment can be instituted.