Author(s)
Christopher Shumrick, BS
Sanjeet RangarajanAdam Vasconcellos, MD
Marc Rosen, MD
Gurston Nyquist, MD
Mindy Rabinowitz, MD
Affiliation(s)
Thomas Jefferson University
Abstract:
Background: Sellar abscess is an uncommon finding, which can be caused by various sources including hematogenous spread to the pituitary gland, extension of a neighboring infection, and transphenoidal iatrogenic seeding. Sellar abscess as a complication of routine endoscopic sinus surgery (ESS) has not been reported in the literature. Here we report our experience with two cases of sellar abscesses following ESS.Methods: A review of the pituitary experience at our institution yielded two patients presenting with sellar abscess with extension to the cavernous sinus following uncomplicated ESS at an outside institution. Pertinent clinical details were reviewed and compared with previous reports in the literature. Results: Both patients presented within three weeks of their initial ESS procedures with septic shock, headache, visual changes, and cranial neuropathies. Neither patient had been diagnosed with sphenoid sinusitis or undergone sphenoid sinusotomy previously. MRI was performed which revealed fluid densities within the sella with extension to the left cavernous sinus in both cases. An endoscopic approach to the cavernous sinus for drainage was employed for both patients. Cultures yielded polymicrobial growth. To our knowledge, this is the first reported series of sellar abscesses following ESS without concurrent sphenoidotomy.Conclusions: Although rare, sellar abscesses can occur following endoscopic sinus surgery, resulting in significant morbidity and risk for mortality. Based on our case series, instrumentation of the sphenoid sinus is not a prerequisite for developing a sellar abscess, and additional study to determine the risk factors for this condition is necessary.