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Updated: Aug 23, 2025
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Position-dependent pressure pneumocephalus after transsphenoidal surgery: illustrative case
Olli-Pekka Kämäräinen1,2, Tatu Kemppainen3, Elina Penttilä3
11Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Journal of Neurosurgery. Case Lessons
|October 28, 2022
Summary
A rare case of tension pneumocephalus after pituitary surgery caused intermittent vision loss due to a valve-like sellar floor defect. Symptoms resolved when lying down, allowing air to escape.
Area of Science:
- Neurosurgery
- Ophthalmology
- Radiology
Background:
- Intracranial air can cause tension pneumocephalus and neurological symptoms post-neurosurgery.
- A unique case of position-dependent tension pneumocephalus occurred after pituitary adenoma resection.
Purpose of the Study:
- To report a unique case of intermittent visual symptoms caused by position-dependent tension pneumocephalus.
- To highlight a rare complication of transsphenoidal surgery.
Main Methods:
- A tiny sellar floor defect created a valve mechanism for air accumulation.
- Magnetic resonance imaging (MRI) confirmed air escape and suprasellar space relaxation in a horizontal position.
Main Results:
- Position-dependent tension pneumocephalus caused intermittent visual field defects when upright.
- Symptoms resolved in a supine position due to air escape and reduced optic chiasm compression.
Conclusions:
- A small sellar floor defect can act as a valve, leading to intermittent suprasellar air accumulation.
- Tension pneumocephalus within an empty tumor capsule is a rare but possible complication after transsphenoidal surgery.
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