Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection.
OBJECTIVE
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Yorgason
Joshua G
JG
Columbia University, College of Physicians & Surgeons, New York.
Arthur
Adam S
AS
Department of Neurosurgery and Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Orlandi
Richard R
RR
Department of Neurosurgery and Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Apfelbaum
Ronald I
RI
Department of Neurosurgery and Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah. Ronald.apfelbaum@hsc.utah.edu.|Department of Neurosurgery, University of Utah School of Medicine, 30 North 1900 East, Suite 3B409, Salt Lake City, UT, 84132, USA. Ronald.apfelbaum@hsc.utah.edu.
D000236:Adenoma / Q000601:surgery*; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D006261:Headache / Q000209:etiology; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011007:Pneumocephalus / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D014786:Vision Disorders / Q000209:etiology