scholarly journals Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Soichi Oya ◽  
Junichiro Kumai ◽  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Wall ◽  
Rare Clinical Entity ◽  
Pituitary Abscess ◽  
Abscess Drainage ◽  
Postoperative Course ◽  
Fluid Leak

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery

2009 ◽  
Vol 151 (11) ◽  
pp. 1427-1430 ◽  
Author(s):  
Hiroshi Nishioka ◽  
Hitoshi Izawa ◽  
Yukio Ikeda ◽  
Hiroaki Namatame ◽  
Shinjiro Fukami ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Dural Suturing ◽  
Fluid Leak

Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine

1981 ◽  
Vol 54 (6) ◽  
pp. 839-841 ◽  
Author(s):  
Angelita Ramos-Gabatin ◽  
Richard M. Jordan
Keyword(s):  
Cerebrospinal Fluid ◽  
Amphotericin B ◽  
Transsphenoidal Surgery ◽  
Combined Therapy ◽  
Sella Turcica ◽  
Single Patient ◽  
Pituitary Abscess ◽  
Content Type ◽  
Elevated Protein ◽  
Fine Print

✓ Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases have been of bacterial etiology; however, a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species has been reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. In the present case, a woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of cerebrospinal fluid. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis, or cerebrospinal fluid abnormalities, including pleocytosis, depressed glucose, and elevated protein.

scholarly journals Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas

Medicina ◽  
2008 ◽  
Vol 44 (4) ◽  
pp. 302 ◽  
Author(s):  
Arimantas Tamašauskas ◽  
Kęstutis Šinkūnas ◽  
Wolfgang Draf ◽  
Vytenis Deltuva ◽  
Algimantas Matukevičius ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Surgical Removal ◽  
Dural Defect ◽  
Sphenoidal Sinus ◽  
Autologous Fat ◽  
Csf Leakage ◽  
Dural Defects ◽  
Fluid Leak

Objectives. The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods. Methods. During the period from 1995 to 2005, 313 patients underwent 356 transsphenoidal operations for pituitary adenoma. Microadenoma was found in 80 (22.5%) cases, and in 276 (77.5%) cases, macroadenoma was removed. Two different methods to close the sella were used. The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone. In more resent practice, the regenerated oxidized cellulose (Surgicel®) and collagen sponge with human fibrin (TachoSil®) were used to cover the sella membrane defect, followed by packing the sella with autologous fat and covering the dural defect with Surgicel® and TachoSil®. Results. Adenoma was totally removed in 198 (55.6%) cases out of 356. Microadenoma was totally removed in 91.3% and macroadenoma in 45.3% of cases, respectively. Postoperative complications were noted in 40 (11.2%) patients. Two (0.6%) patients died after surgery. Intraoperative CSF leakage was observed in 58 (16.3%) cases. Postoperative CSF leakages were observed in 3 cases, when the method of packing the sella with just autologous fat was used, whereas in 29 cases when the sella fat packing was used together with Surgicel® and TachoSil® to cover the sella membrane and dural defects, no postoperative CSF leakages were observed. Conclusions. The technique of covering the sella membrane and dural defects with Surgicel® and TachoSil® in the presence of intraoperative CSF leakage appeared to be the most reliable one, as no postoperative CSF leakage applying this technique has been observed.

scholarly journals Bone morphogenetic protein in the repair of cerebrospinal fluid leak after transsphenoidal surgery

2019 ◽  
Vol 14 (2) ◽  
pp. 607 ◽  
Author(s):  
Dejan Slavnic ◽  
RichardFloyd Cook ◽  
Matthew Bahoura ◽  
Gijong Paik ◽  
DorisWL Tong ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bone Morphogenetic Protein ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Morphogenetic Protein ◽  
Fluid Leak
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