Herniation of the Third Ventricle into Empty Sella Caused by Surgery for Pituitary Apoplexy —Case Report—

Kobayashi, Seiichiro; Otsuka, Akiyoshi; Tsunoda, Tadao

doi:10.2176/nmc.36.451

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…[ 1 ] One earlier case report of meningitis following Rathke's cyst repair due to PEIR was managed successfully by the endonasal endoscopic transsphenoidal approach. [ 2 ] We managed this case by dissecting and freeing the sac from the posterior septal wall, defining the edges of the defect and multilayer reconstruction of the defect using fat, nasal cartilage, fascia, and reflected mucosal Hadad flap based on the sphenopalatal artery.…”

Section: Discussionmentioning

confidence: 99%

Persisting embryonal infundibular recess masquerading as a nasal mass

et al. 2018

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Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the development of the posterior pituitary wherein there is a defect in the third ventricular floor. Earlier reports have found PEIR descending only up to the sella. However, this is the first case of PEIR presenting as a pulsatile nasal mass. A 35-year-old female presented to the otorhinolaryngologist with hyposmia. Diagnostic nasal endoscopy revealed a pulsatile nasal mass. Magnetic resonance imaging revealed a cystic lesion extending from the third ventricular floor to the nasal cavity. There was no associated hydrocephalus or empty sella. The case was successfully managed by the endoscopic endonasal transsphenoidal approach.

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Section: Discussionmentioning

confidence: 99%

Persisting embryonal infundibular recess masquerading as a nasal mass

et al. 2018

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Delayed Visual Deterioration After Surgery for Pituitary Adenoma

Czech

Wolfsberger

Reitner

et al. 1999

Acta Neurochirurgica

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Despite its description in the literature there remains uncertainty about the incidence, the pathophysiological basis and the best management of a delayed visual deterioration in the presence of an empty sella after surgery for pituitary adenomas. Out of a series of 501 patients with pituitary adenomas operated on at our institution between 1984 and 1996, four patients (0.8%) developed a worsening of their visual function 3 to 37 months after surgery in the absence of tumour recurrence. None of the patients had received radiotherapy. Magnetic resonance imaging (MRI) ruled out compression by tumour and showed herniation of suprasellar structures into an empty sella. In three cases re-operation by a subfrontal approach with freeing of the optic structures from tethering scar tissue led to an improvement of visual deficits. In one case a spontaneous recovery was initiated by a minor head injury. Although apparently a rare event, our cases provide evidence for the occurrence of a potentially reversible delayed deterioration of visual function after surgery for pituitary adenomas. Based on our operative findings and our outcome we recommend re-operation by a transcranial approach in patients in whom repeated ophthalmological testing does not show spontaneous improvement within a short period of time.

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