Abstract
Transsphenoidal pituitary adenoma surgery is related to a low morbidity rate. The complications that can occur are classified as intra- and extracranial. The aim of the study is to discuss one group of these complications involving the sphenoid sinus: mucocele and its possible transformation into pyocele. We evaluate clinical presentation, management strategy and the outcome after long-term follow-up presenting an explicative case and a review of the literature. A patient presented to our outpatient clinic 8 months after transsphenoidal surgery for selective removal of a pituitary adenoma because of an acute onset of frontal headache during an airplane travel, fever and pulsating sensation in left eye and ear. MRI revealed a contrast-enhancing lesion in the left inferior portion of the sphenoid sinus. An endonasal endoscopic revision of the sphenoid sinus was performed. After opening of the scar to enter in the left sinus a pyocele was found and treated with drainage and marsupialisation. Development of sphenoid sinus pyocele is an extremely rare postoperative complication of transsphenoidal surgery. This lesion should be taken in consideration in patients presenting with retroorbital headache of acute onset and fever after pituitary surgery. Diagnosis can be suspected on the MRI studies and confirmed by a targeted flexible endoscope examination. Endoscopic drainage with wide opening of the sphenoid sinus and marsupialisation is the treatment of choice to avoid recurrences.
Similar content being viewed by others
References
Kanter AS, Dumont AS, Asthagiri AR, Oskouian RJ, Jane JA Jr, Laws ER Jr (2005) The transsphenoidal approach. A historical perspective. Neurosurg Focus 18(4):e6. doi:180406
Nimsky C, von Keller B, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59(1):105–114. doi:10.1227/01.NEU.0000219198.38423.1E discussion 105–114
Buchfelder M, Fahlbusch R (1996) Complications of transsphenoidal surgery. In: Landolt AU (ed) Pituitary tumors. Springer-Verlag, Wien
Buchinsky FJ, Gennarelli TA, Strome SE, Deschler DG, Hayden RE (2001) Sphenoid sinus mucocele: a rare complication of transsphenoidal hypophysectomy. Ear Nose Throat J 80(12):886–888
Kessler L, Legaludec V, Dietemann JL, Maitrot D, Pinget M (1999) Sphenoidal sinus mucocele after transsphenoidal surgery for acromegaly. Neurosurg Rev 22(4):222–225
Bahadir O, Imamoglu M, Bektas D (2006) Massive concha bullosa pyocele with orbital extension. Auris Nasus Larynx 33(2):195–198. doi:10.1016/j.anl.2005.11.007
Eloy P, Bachy V, Grulois V, Bertrand B (2008) Pyocele of the lachrymal sac: a late and unusual complication after surgery for a juvenile nasopharyngeal angiofibroma. Clin Ophthalmol 2(1):211–215
Robinson K, Fosket CD, Fraccola PJ (1990) Cases of the day. General. Frontal pyocele with nasal polyposis. Radiographics 10(4):732–734
Yamasoba T, Kikuchi S (1993) Intracranial complications resulting from frontal pyocele: case presentation and review of experience in Japan. Head Neck 15(5):450–454
Lu YJ, Chang CN, Pai PC, Wei KC, Chuang CC (2009) Isolated sphenoid sinusitis or mucocele: a potential complication of endonasal transsphenoidal surgery. J Neurooncol 91(1):63–67. doi:10.1007/s11060-008-9681-7
Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature and personal experience. Neurosurgery 40(2):225–236 discussion 236–227
Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55(4):933–940 discussion 940–931
Kilty SJ, McLaughlin N, Bojanowski MW, Lavigne F (2010) Extracranial complications of endoscopic transsphenoidal sellar surgery. J Otolaryngol Head Neck Surg 39(3):309–314
Lui YW, Dasari SB, Young RJ (2010) Sphenoid masses in children: radiologic differential diagnosis with pathologic correlation. AJNR Am J Neuroradiol 1–10 (Epub ahead of print)
Yuca K, Kiris M, Kiroglu AF, Bayram I, Cankaya H (2008) A case of concha pyocele (concha bullosa mucocele) mimicking intranasal mass. B-ENT 4(1):25–27
Giusan AO, Uzdenova R (2003) Pyocele of the frontal sinus with extensive destruction of the anterior, posterior and paranasal sinus bone walls. Vestn Otorinolaringol 3(4):65–66
Nakayama T, Mori K, Maeda M (1998) Giant pyocele in the anterior intracranial fossa: case report. Neurol Med Chir (Tokyo) 38(8):499–502. doi:JST.Journalarchive/nmc1959/38.499
Matyja G, Kawczynski M, Tarnowska C (2006) Pyocele of the posterior ethmoidal cell as the cause of visual loss. Otolaryngol Pol 60(2):171–174
Draf W, Weber R, Keerl R, Constantinidis J (1995) Current aspects of frontal sinus surgery. I: endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses. HNO 43(6):352–357
Weber R (2009) Endonasal frontal sinus surgery. Part 1: frontal sinus drainage, types I and II. HNO 57(8):739–750. doi:10.1007/s00106-008-1751-9
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Giordano, M., Gerganov, V.M., Draf, W. et al. Sphenoid sinus pyocele after transsphenoidal approach for pituitary adenoma. Pituitary 15, 188–192 (2012). https://doi.org/10.1007/s11102-011-0305-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-011-0305-4