Endoscopic Decompression of Tension Pneumosella Following Transsphenoidal Pituitary Tumor Resection

Abstract

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.

Pneumatocele selar a tensión: Reporte de un caso y revisión de la literatura

“…Al igual que en el presente caso, se manifestó clínicamente como hemianopsia bilateral, la cual se resolvió completamente tras la reoperación por vía transesfenoidal. [22] Por su parte, Lee y col publicaron un caso de pneumatocele selar y supraselar entre más de 2000 cirugías transesfenoidales realizadas, en el cual el piso selar había sido reparado con grasa. La presentación clínica también había sido la disminución de la agudeza visual.…”

“…En este caso, se utilizó el abordaje transciliar, lográndose el éxito terapéutico sin complicaciones asociadas al abordaje. [131522]…”

Complications of Transsphenoidal Hypophysectomy

“…Pneumosella (i.e., air confi ned to the sella) can also rarely occur, and it presents uniquely as progressive bitemporal hemianopsia, a change in vision, and with variably occurring headache 2 to 4 weeks after surgery. Yorgason and colleagues 22 reported a patient with increasing visual symptoms 6 months after the resection of a nonsecreting benign pituitary adenoma with suprasellar extension. The endoscopic decompression of the pneumosella was performed.…”

“…The pneumosella recurred, and the patient was subsequently successfully reconstructed with a fat graft. 22 The avoidance of heavy lifting, straining, and nose blowing after transsphenoidal surgery are imperative to prevent pneumocephalus and pneumosella. Other neurologic sequelae including stroke and seizure occur in up to 1% of transsphenoidal procedures (see Table 45-2).…”

Oculocardiac reflex during endoscopic transsphenoidal removal of pituitary adenoma

“…The mechanisms involved in visual complications include direct injury or devascularisation of the optic apparatus, fracture of the orbit, postoperative haematoma, cerebral vasospasm and prolapse of the optic chiasm into an empty sella[1] and tension pneumosella. [2] During the postoperative period, our patient developed bilateral vision loss that may be due to tumour residue and optical chiasmal compression by sellar haematoma. However, intraoperative events of repeat bradycardia, possibly resulting from the oculocardiac reflex cannot be ignored.…”