Progressive visual loss because of a suprasellar pneumatocele after trans-sphenoidal resection of a pituitary adenoma.
A 63-year-old man who underwent uneventful trans-sphenoidal resection of a pituitary adenoma with fat packing complained postoperatively of progressive binocular visual acuity loss. Neuroimaging showed a suprasellar pneumatocele compressing the optic chiasm and a communication between the sphenoid sinus and the sella. After a second trans-sphenoidal procedure to remove the air and fully pack the sphenoid sinus, visual acuity recovered dramatically. A rare complication of trans-sphenoidal surgery for pituitary adenoma, suprasellar pneumatocele probably forms through a ball-valve mechanism that results from incomplete packing of the sellar floor. This case highlights the need for effective sphenoid sinus packing and for ophthalmic monitoring after trans-sphenoidal surgery.
Lee
Andrew G
AG
Departments of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. andrew-lee@uiowa.edu
Van Gilder
John C
JC
White
Matthew L
ML
D000236:Adenoma / Q000601:surgery*; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011007:Pneumocephalus / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012658:Sella Turcica; D013101:Sphenoid Sinus / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology; D014794:Visual Fields