Surgical Neurology International 2012 3(7):395-399
Background: Tension pneumocephalus is uncommon after transsphenoidal surgery. There are only few cases reported in the literature in which the air was located at the sellar region exclusively, constituting a sellar pneumocele. In this article, an unusual case of a late onset tension sellar pneumocele is reported. Case Description: A 57-year-old woman consulted because of bitemporal hemianopsia. She had undergone a transnasal surgery for pituitary adenoma and a shunt had been placed because of the presence of cerebrospinal fluid leakage. Furthermore, the patient had undergone a transcranial resection of an intracavernous component of the tumor and radiosurgical treatment had been perfomed too because of its aggressiveness. A magnetic resonance imaging was undertaken and it demonstrated a sellar and suprasellar pneumocele. Intervention: A transcilliary approach was performed. The sellar region was enclosed by scarring tissue from her earlier procedures. The scar was opened and the air was evacuated. The sellar floor was subsequently closed with fat and fibrin glue. After the procedure, her visual field returned to normal. One year after her last surgery, she is still asymptomatic. Conclusion: Sellar and suprasellar tension pneumocele is an extremely rare finding following transsphenoidal surgery. Its clinical manifestation would be visual disturbance due to compression on the optic pathway from below. When diagnosed, tension sellar pneumocele should be evacuated within a short time frame.