Fig. 75.1
Postoperative pituitary abscess. (a) Sagittal T1-weighted gadolinium-enhanced MR image. (b) Coronal T1-weighted gadolinium-enhanced image. A peripherally enhancing lesion in the sella displaces the pituitary stalk superiorly. The wall of the lesion is thick and irregular
75.3 Histopathology
A wide variety of bacterial and fungal organisms have been implicated in the formation of sellar abscesses.
Histopathology may demonstrate necrosis and abscess wall, with infiltration by polymorphonuclear leukocytes or macrophages [2].
In over 80 % of cases, organisms are not isolated on cultures [10].
PCR (polymerase chain reaction) testing may be useful in establishing a definitive diagnosis.
75.4 Clinical and Surgical Management
The diagnosis of sellar abscess is often missed prior to surgery, but it should be considered for postoperative patients [10].
The standard management includes transsphenoidal surgical drainage and marsupialization of the abscess wall [10, 17].
In some cases, conservative management with antibiotics may be attempted, but there is little evidence to support this management strategy [18].
Intraoperative cultures for aerobic, anaerobic, fungal, and acid-fast bacilli should be used.
Sellar floor reconstruction is not recommended unless a CSF leak is present.
For bacterial abscesses, intravenous antibiotics are typically required for at least 6 weeks after drainage.
Tubercular or fungal abscesses should be treated with the appropriate antibiotic regimens.
Symptoms from mass effect generally improve following drainage, whereas hypopituitarism typically fails to do so [6, 19].
References
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2.
3.
Jain KC, Varma A, Mahapatra AK. Pituitary abscess: a series of six cases. Br J Neurosurg. 1997;11:139–43.CrossRefPubMed
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