Suprasellar tension pneumocyst after transsphenoidal surgery

Abstract

Tension pneumocephalus is an uncommon occurrence after transsphenoidal surgery. The author presents an unusual case of postoperative visual deterioration related to expanding air within a suprasellar tumor cavity.

Endoscopic Decompression of Tension Pneumosella Following Transsphenoidal Pituitary Tumor Resection

“…Patients with this complication distinctly present with progressively deteriorating vision and bitemporal hemianopsia and, sometimes, a headache [7][8][9]. Tension pneumosella usually occurs a few weeks after surgery [7][8][9], but our case suggests that it can develop months later. Because it presents subacutely, tension pneumosella seems to be clinically distinct from acute complications of surgery, such as hemorrhage or infarction affecting the optic apparatus.…”

“…Tension pneumosella is a rare surgical complication that has only been reported three times previously [7][8][9]. It is possible that this condition is under-reported, as it has only recently been recognized.…”

“…This rare postoperative complication has only recently been reported under descriptors including "suprasellar tension pneumocyst" [7,8] and "suprasellar pneumatocele" [9]. Patients with this complication distinctly present with progressively deteriorating vision and bitemporal hemianopsia and, sometimes, a headache [7][8][9].…”

“…Once diagnosed, tension pneumosella should be managed aggressively as it can lead to permanent visual changes [9] that can be avoided with surgical decompression [7][8][9]. As described previously [8], we used minimally invasive transnasal endoscopy to decompress the air in the sella.…”

“…Only a few reports have described expanding air confined to the sellar region after transsphenoidal surgery [7][8][9]. We report a rare case of tension pneumosella causing acute visual changes with recovery following endoscopic surgical decompression.…”