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Case Reports
. 2020 Aug 28;15(3):763-765.
doi: 10.4103/ajns.AJNS_253_19. eCollection 2020 Jul-Sep.

Suprasellar Tension Pneumatocele after Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma

Anil Kumar Sharma  1 , Rupa Mehta  2 , Naman Chandrakar  1 , Nikhil Singh  2 , Nitin M Nagarkar  2
Affiliations
Case Reports

Suprasellar Tension Pneumatocele after Endoscopic Transsphenoidal Surgery for Pituitary Macroadenoma

Anil Kumar Sharma et al. Asian J Neurosurg. .

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.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative sagittal (a) and coronal (b) gadolinium-enhanced magnetic resonance images shows large pituitary tumor with suprasellar extension
Figure 2
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
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
See this image and copyright information in PMC

References

    1. Lee AG, Van Gilder JC, White ML. Progressive visual loss because of a suprasellar pneumatocele after trans-sphenoidal resection of a pituitary adenoma. J Neuroophthalmol. 2003;23:142–4. - PubMed
    1. Yorgason JG, Arthur AS, Orlandi RR, Apfelbaum RI. Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection. Pituitary. 2004;7:171–7. - PubMed
    1. Sawka AM, Aniszewski JP, Young WF, Jr, Nippoldt TB, Yanez P, Ebersold MJ. Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo clinic experience 1976-1998. J Clin Endocrinol Metab. 1999;84:4731–4. - PubMed
    1. Brown LJ. Suprasellar tension pneumocyst after transsphenoidal surgery. Case report. J Neurosurg. 1998;89:146–8. - PubMed
    1. Altinörs N, Arda N, Kars Z, Türker A, Senveli E, Cepoǧlu C, et al. Tension pneumocephalus after transsphenoidal surgery: Case report. Neurosurgery. 1988;23:516–8. - PubMed

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