Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection

Joshua G. Yorgason, Adam Arthur, Richard R. Orlandi, Ronald I. Apfelbaum

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective and importance: Tension pneumosella is an extremely rare complication of transsphenoidal surgery, having been reported only three times previously. Patients who develop this expanding pneumocele confined to the sella present with visual field changes consistent with optic chiasm compression. If left untreated, this condition can lead to permanent visual deficits. We report a case of tension pneumosella after transsphenoidal resection of a benign pituitary adenoma that was successfully treated endoscopically. Clinical presentation: Six months after transsphenoidal resection of a pituitary tumor, a 70-year-old man presented with subjective vision loss and was found on formal testing to have bitemporal hemianopsia. A diagnosis of tension pneumosella was made with a head CT after tumor recurrence was ruled out with MRI. The expanding pneumocele developed after vigorous nose blowing in the setting of a surgical sellar floor defect and an intact diaphragma sellae. Intervention: The pneumocele was endoscopically decompressed using a transnasal approach guided by frameless stereotaxy. An immediate decrease in the amount of air was confirmed with intraoperative fluoroscopy. The defect was subsequently repaired with a hemostatic agent and fibrin glue. The patient rapidly recovered his vision and went home on postoperative day one with no further visual complications. Conclusion: Tension pneumosella should be considered as a possible diagnosis in patients presenting with subacute visual field deficits after transsphenoidal pituitary region surgery. Endoscopy may play a valuable role in the diagnosis and management of this rare phenomenon, as well as other more common complications of transsphenoidal surgery.

Original languageEnglish (US)
Pages (from-to)171-177
Number of pages7
JournalPituitary
Volume7
Issue number3
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

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Pituitary Neoplasms
Decompression
Visual Fields
Neuronavigation
Hemianopsia
Optic Chiasm
Fibrin Tissue Adhesive
Fluoroscopy
Hemostatics
Nose
Endoscopy
Air
Head
Recurrence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection. / Yorgason, Joshua G.; Arthur, Adam; Orlandi, Richard R.; Apfelbaum, Ronald I.

In: Pituitary, Vol. 7, No. 3, 01.10.2004, p. 171-177.

Research output: Contribution to journalArticle

Yorgason, Joshua G. ; Arthur, Adam ; Orlandi, Richard R. ; Apfelbaum, Ronald I. / Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection. In: Pituitary. 2004 ; Vol. 7, No. 3. pp. 171-177.
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