Iatrogenic Pituitary Abscess

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].
Recurrence rates have been reported to range from 0 to 18 % following surgical and antibiotic management of sellar abscess [6, 10].

References

Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol. 2007;156:203–16.CrossRefPubMed

Dutta P, Bhansali A, Singh P, Kotwal N, Pathak A, Kumar Y. Pituitary abscess: report of four cases and review of literature. Pituitary. 2006;9:267–73.CrossRefPubMed

Jain KC, Varma A, Mahapatra AK. Pituitary abscess: a series of six cases. Br J Neurosurg. 1997;11:139–43.CrossRefPubMed

Only gold members can continue reading. Log In or Register to continue