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Published on: March 2, 2020
Primary Sellar Abscesses: A Systematic Review and 2 Rare Observations
Alexey Nikolaevich Shkarubo1, Ilia Valerievich Chernov1, Igor Nikolaevich Pronin1
1N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
Background:
Abscesses of the chiasmatic-sellar region are quite rare and are often a result of surgical intervention, trauma, or tumor growth. Primary abscesses are extremely rare and represent a group of abscesses the occur because of internal microbial seeding. Primary abscesses are rarely reported. We present 2 clinical cases featuring primary abscesses of the chiasmal-sellar region. To put into perspective the rarity of these findings, we performed a systematic review of existing clinical reports regarding this pathology.
Methods:
A systematic review of literature was conducted to gather existing clinical reports on primary abscesses of the chiasmatic-sellar region. Two personal findings are added to the literature review, including a 13-year-old girl and a 58-year-old man who presented with chiasmal-sellar region primary abscesses. The diagnostic aspects, treatment strategy, and outcomes are discussed.
Results:
Both patients included in the report had positive outcome. The pediatric patient developed a recurrence of the abscess and was treated accordingly. Overall, 41 cases of primary abscesses of this region have been reported in literature, of which 6 are in children under 18 years of age. The main nonspecific clinical manifestations include headaches, visual impairment, and endocrine pathology. Acute inflammatory responses are rarely seen, despite infectious genesis. Transnasal endoscopic surgical treatment offers diagnostic and treatment advantages.
Conclusions:
Proper diagnostic procedures can aid in correct treatment strategy and improve overall outcome.
Insights
Primary abscesses of the chiasmatic-sellar region are exceptionally rare, with only 41 cases reported. Early diagnosis and transnasal endoscopic surgery are key to successful treatment outcomes for these rare brain abscesses.
Area of Science:
- Neuroscience
- Infectious Diseases
- Endocrinology
Background:
- Abscesses in the chiasmatic-sellar region are uncommon, often secondary to surgery, trauma, or tumors.
- Primary abscesses, resulting from internal microbial seeding, are exceedingly rare and infrequently reported in medical literature.
Observation:
- This report details two cases of primary chiasmatic-sellar region abscesses, one in a pediatric patient and another in an adult.
- A systematic literature review was performed to contextualize these rare findings, gathering existing clinical reports on this specific pathology.
Findings:
- A total of 41 primary abscesses of the chiasmatic-sellar region have been documented, with only 6 occurring in individuals under 18.
- Common symptoms include headaches, visual disturbances, and endocrine dysfunction, often without overt signs of acute inflammation.
- Transnasal endoscopic surgery demonstrated advantages in both diagnosis and treatment, leading to positive outcomes in the presented cases, despite one recurrence.
Implications:
- Accurate diagnostic methods are crucial for selecting the optimal treatment strategy.
- Effective management of these rare abscesses can lead to improved patient outcomes and prognosis.
