title: Intrasellar abscess following pituitary surgery.
abstract: OBJECTIVE
  Intrasellar abscess is an uncommon cause of mass lesions in the sella turcica. Few cases have been reported in the literature, and much remains unknown about the etiology and diagnosis of these lesions. We sought to review a series of patients with intrasellar abscess encountered at our institution and identify defining characteristics of their presentation and management.
  
  
  METHODS
  We conducted a retrospective chart review for intrasellar infection cases associated with a mass lesion. Included cases had clear demonstration of a mass lesion on imaging with subsequent positive microbiological cultures. Clinical presentation, management, post-operative course, neuroimaging, microbiology, and any perturbations in serum pituitary biochemical markers were examined.
  
  
  RESULTS
  All examined patients had a history of antecedent transsphenoidal pituitary surgery within the preceding 10 months. All presented with headaches, three with progressive visual loss, one with meningismus, one with fever in the setting of an active cerebrospinal fluid leak, and one with fever, meningismus, hypotension, and progressive somnolence. No patient presented with acute endocrine abnormalities. A majority did not initially have any diffusion restriction present on MRI, but in one case we were able to track the evolution of diffusion restriction over sequential MRI scans. Two patients had complete resolution of presenting symptoms, while three experienced improvement or stabilization of their neurologic deficit. There were no mortalities.
  
  
  CONCLUSIONS
  Pituitary abscess remains a rare diagnosis that can be difficult to make and to confirm. In our series we found a strong association between culture-positive abscess and recent pituitary surgery. When present, prompt treatment with surgical drainage and aggressive post-operative antibiotics can lead to a favorable outcome.
authors: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA, 02115, USA.
authors: Kevin T
authors: KT
authors: Huang
authors: Wenya Linda
authors: WL
authors: Bi
authors: Timothy R
authors: TR
authors: Smith
authors: Amir A
authors: AA
authors: Zamani
authors: Ian F
authors: IF
authors: Dunn
authors: Edward R
authors: ER
authors: Laws
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001900:Boston; D001922:Brain Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D004322:Drainage; D013507:Endocrine Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D010902:Pituitary Gland / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012658:Sella Turcica / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents