Septic cavernous sinus thrombosis following transsphenoidal craniotomy. Case report

Area of Science:

• Neurosurgery
• Infectious Diseases
• Ophthalmology

Background:

• Transsphenoidal craniotomy is a common surgical approach for pituitary macroadenomas.
• Cavernous sinus thrombosis (CST) is a rare but serious complication, typically associated with facial infections.
• Late-onset complications following neurosurgery require careful consideration and prompt management.

Purpose of the Study:

• To report the first known case of septic cavernous sinus thrombosis occurring 9 weeks after transsphenoidal craniotomy for a pituitary macroadenoma.
• To highlight the diagnostic challenges and successful management of this rare post-operative complication.

Main Methods:

• A 74-year-old male patient presented with headache, ophthalmoplegia, and orbital congestion 9 weeks post-transsphenoidal craniotomy.
• Initial broad-spectrum antibiotic therapy was ineffective.
• A second transsphenoidal craniotomy was performed for abscess drainage, with intraoperative cultures identifying Streptococcus, Staphylococcus, and Haemophilus influenzae.

Main Results:

• The patient received 6 weeks of intravenous antibiotic therapy tailored to the identified pathogens.
• Complete clinical recovery was achieved following surgical drainage and targeted antibiotic treatment.
• This case represents the initial documented instance of septic cavernous sinus thrombosis post-transsphenoidal surgery.

Conclusions:

• Septic cavernous sinus thrombosis is a potential, albeit rare, late complication of transsphenoidal craniotomy.
• Early diagnosis, surgical intervention for abscess drainage, and appropriate antibiotic therapy are crucial for favorable outcomes.
• This case underscores the importance of considering infectious complications even weeks after pituitary surgery.