Suprasellar Tension Pneumatocele after Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma

Abstract

Tension pneumatocele is a very rare but potentially fatal complication of transsphenoidal surgery that can result from an influx of air into the intracranial cavity through the cerebrospinal fluid fistula. Although transsphenoidal surgeries for pituitary adenomas are very commonly performed procedures, this complication is extremely rare. We report a case of tension pneumatocele after transsphenoidal resection of a pituitary macroadenoma. After a second endoscopic transsphenoidal procedure to remove the air and repair of the sella floor, visual acuity recovered dramatically. Tension pneumatocele is an uncommon but potentially lethal complication of transsphenoidal pituitary surgery, which can present anytime, even after years postoperatively. It is important for all skull base surgeons to be aware of this condition so that prompt treatment can be instituted.

Keywords: Pituitary adenoma; tension pneumatocele; transsphenoidal.

Figure 1

Preoperative sagittal (a) and coronal (b) gadolinium-enhanced magnetic resonance images shows large pituitary tumor with suprasellar extension

Figure 2

On the postoperative day 3, the patient developed severe headache and sudden visual deterioration. CT of the head (a) demonstrates suprasellar tension pneumatocele. The patient underwent emergent endoscopic exploration and revision of the skull base repair was performed to obliterate a ball-valve fistula. (b) Postoperative computed tomography (CT) demonstrates resolution of the tension pneumatocele

Figure 3

Intraoperative fluoroscopy was used to verify adequate decompression of the tension pneumatocele, (a) before starting surgery, (b) prior to closure of the operation