Pituitary abscess following transsphenoidal surgery: the experience of 12 cases from a single institution

Clin Neurol Neurosurg. 2014 Sep:124:66-71. doi: 10.1016/j.clineuro.2014.06.028. Epub 2014 Jul 1.

Abstract

Objective: To explore possible reasons for the incidence of a pituitary abscess following transsphenoidal surgery and determine the most effective treatment.

Methods: A series of 12 patients who had undergone transsphenoidal surgery in other hospitals before being treated at Peking Union Medical College Hospital were reviewed. The presence of a pituitary abscess was confirmed when pus was intraoperatively observed within the sella turcica. All patients were treated with debridement of the abscess, nine among whom through a transsphenoidal approach and the other three via a craniotomy, followed by antibiotic treatment and hormone replacement therapy. The mean follow-up time was 27.0 months (range from 3.0 to 79.0 months).

Results: Headache (92%), panhypopituitarism (58%) and visual disturbance (50%) were the most common clinical indicators of a pituitary abscess. Imaging tests demonstrated a pituitary mass in all patients, with seven (58%) manifested with typical magnetic resonance features of an abscess. Ten patients (83%) were correctly diagnosed preoperatively. During surgical exploration, six presented with severe inflammation or an abscess within the sphenoidal sinus. Causative organisms were identified in five patients (42%). After surgical and antibiotic therapies, all patients fully recovered except for two presenting with severe visual impairment. Six patients (50%) required hormone replacement therapy.

Conclusion: Retrograde infection from the sphenoid sinus may be a vital mechanism underlying the formation of a pituitary abscess following transsphenoidal surgery. Debridement of the abscess through surgical approaches combined with antibiotic treatment has been found to yield positive outcomes.

Keywords: Abscess; Adenoma; Hypopituitarism; Pituitary; Transsphenoidal surgery.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Brain Abscess / drug therapy
  • Brain Abscess / etiology
  • Brain Abscess / surgery*
  • Debridement / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects*
  • Pituitary Diseases / drug therapy
  • Pituitary Diseases / etiology
  • Pituitary Diseases / surgery*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery*
  • Retrospective Studies
  • Sphenoid Sinus / microbiology
  • Sphenoid Sinus / surgery*
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents