Department of Neurosurgery, International Neuroscience Institute, Rudolf-Pichlmayer-Straße. 4, 30625, Hannover, Germany.
Pituitary. 2012 Jun;15(2):188-92. doi: 10.1007/s11102-011-0305-4.
Transsphenoidal pituitary adenoma surgery is related to a low morbidity rate. The complications that can occur are classified as intra- and extracranial. The aim of the study is to discuss one group of these complications involving the sphenoid sinus: mucocele and its possible transformation into pyocele. We evaluate clinical presentation, management strategy and the outcome after long-term follow-up presenting an explicative case and a review of the literature. A patient presented to our outpatient clinic 8 months after transsphenoidal surgery for selective removal of a pituitary adenoma because of an acute onset of frontal headache during an airplane travel, fever and pulsating sensation in left eye and ear. MRI revealed a contrast-enhancing lesion in the left inferior portion of the sphenoid sinus. An endonasal endoscopic revision of the sphenoid sinus was performed. After opening of the scar to enter in the left sinus a pyocele was found and treated with drainage and marsupialisation. Development of sphenoid sinus pyocele is an extremely rare postoperative complication of transsphenoidal surgery. This lesion should be taken in consideration in patients presenting with retroorbital headache of acute onset and fever after pituitary surgery. Diagnosis can be suspected on the MRI studies and confirmed by a targeted flexible endoscope examination. Endoscopic drainage with wide opening of the sphenoid sinus and marsupialisation is the treatment of choice to avoid recurrences.
经蝶窦垂体腺瘤手术的发病率较低。可能发生的并发症分为颅内和颅外两种。本研究旨在讨论涉及蝶窦的一组并发症：黏液囊肿及其可能转化为脓囊肿。我们评估了临床表现、处理策略和长期随访后的结果，通过一个解释性病例和文献复习来阐述这一问题。一名患者在经蝶窦选择性切除垂体腺瘤 8 个月后因在飞机旅行中突发额头痛、发热和左眼及耳部搏动感而到我们的门诊就诊。MRI 显示蝶窦左下部有一个增强的病变。进行了经鼻内镜蝶窦修正术。在切开疤痕进入左侧窦后，发现了一个脓囊肿，并进行了引流和袋形化处理。蝶窦脓囊肿是经蝶窦手术的一种极其罕见的术后并发症。对于垂体手术后出现急性眶后头痛和发热的患者，应考虑到这种病变。在 MRI 研究中可以怀疑诊断，并通过有针对性的软性内镜检查来证实。内镜引流和广泛开放蝶窦的袋形化是避免复发的首选治疗方法。
