Pitfall of fat grafting in pituitary surgery

Acute visual loss following transsphenoidal pituitary surgery is rare but potentially reversible if promptly identified and treated. Migration of fat graft into the sella is an infrequently recognised but treatable cause. A woman in her early 60s presented with pituitary acromegaly and underwent endoscopic endonasal transsphenoidal surgery for a pituitary macroadenoma. Postoperatively, she developed sudden bilateral visual loss. MRI revealed optic chiasm compression by migrated fat graft used for sellar reconstruction. Emergency re-exploration and decompression led to complete restoration of vision. Fat graft migration can cause chiasmal compression and sudden painless vision loss after pituitary surgery. Immediate imaging and decompression are critical for visual recovery.