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Updated: May 27, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Expanded endoscopic endonasal transsphenoidal resection of a rare concurrent sellar pituitary adenoma and suprasellar
Minglu Li1, Zhichun Huang1, Xiang Yao1
1Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian.
Background:
The coexistence of pituitary adenoma and sellar abscess is exceedingly rare, posing diagnostic challenges due to nonspecific clinical and imaging features.
Observations:
A 47-year-old female presented with a 6-month progressive visual decline. MRI revealed a 2.5-cm multicystic sellar-suprasellar lesion with irregular rim enhancement, suspicious for adenoma or craniopharyngioma. Endoscopic endonasal resection revealed typical adenoma tissue in the sellar region and a suprasellar abscess with thick yellow pus. Both lesions were completely resected in a single stage. Histopathological analysis confirmed nonfunctioning pituitary adenoma with concurrent acute suppurative inflammation. Cultures were negative. The patient received 6 weeks of intravenous antibiotic therapy. Postoperatively, transient diabetes insipidus and fever resolved spontaneously. At the 6-month follow-up, MRI showed complete resection with no recurrence, and the patient's vision significantly improved.
Lessons:
Pituitary abscess can rarely coexist with adenoma and mimic common sellar lesions. Single-stage endoscopic endonasal surgery enables simultaneous diagnosis and management of both pathologies. Prolonged antibiotic therapy based on histopathological evidence is essential even with negative cultures. https://thejns.org/doi/10.3171/CASE26194.
Insights
A rare case of pituitary adenoma coexisting with a sellar abscess was successfully treated with single-stage endoscopic surgery. This approach allowed for simultaneous diagnosis and removal of both pathologies, followed by essential antibiotic therapy.
Area of Science:
- Neurosurgery
- Endocrinology
- Pathology
Background:
- The simultaneous occurrence of pituitary adenoma and sellar abscess is exceptionally rare.
- Nonspecific clinical and imaging findings present diagnostic challenges.
Purpose of the Study:
- To report a rare case of coexisting pituitary adenoma and sellar abscess.
- To highlight the efficacy of single-stage endoscopic endonasal surgery for simultaneous diagnosis and management.
Main Methods:
- A 47-year-old female with visual decline underwent MRI, revealing a sellar-suprasellar lesion.
- Endoscopic endonasal resection was performed, followed by histopathological analysis and 6 weeks of intravenous antibiotics.
Main Results:
- Histopathology confirmed a nonfunctioning pituitary adenoma with an acute suppurative abscess.
- Complete resection was achieved in a single stage, with no recurrence at 6 months.
- Postoperative transient diabetes insipidus and fever resolved spontaneously.
Conclusions:
- Pituitary abscesses can rarely coexist with adenomas, mimicking other sellar lesions.
- Single-stage endoscopic surgery is effective for managing both conditions concurrently.
- Prolonged antibiotic therapy is crucial, even with negative cultures.
