Diagnosis and minimally invasive surgery for the pituitary abscess: A review of twenty nine cases

• Published in: Clinical neurology and neurosurgery 2012-09, Vol.114 (7), p.957-961
• Main Authors: Zhang, Xiaoluo, Sun, Jie, Shen, Ming, Shou, Xuefei, Qiu, Huijia, Qiao, Nidan, Zhang, Nan, Li, Shiqi, Wang, Yongfei, Zhao, Yao
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood; Brain Abscess - diagnosis; Brain Abscess - pathology; Brain Abscess - surgery; Cysts; Diabetes; Diabetes Insipidus, Neurogenic - etiology; Diagnosis; Female; Fever - etiology; Follow-Up Studies; Headache - etiology; Headaches; Hormone replacement therapy; Humans; Hypopituitarism - etiology; Male; Medical imaging; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Mortality; Nasal Cavity - surgery; Neurology; Neurosurgery; Neurosurgical Procedures - methods; Pituitary abscess; Pituitary Diseases - diagnosis; Pituitary Diseases - pathology; Pituitary Diseases - surgery; Pituitary Function Tests; Pituitary gland; Pituitary Hormones - blood; Retrospective Studies; Sinuses; Sphenoid Bone - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical treatment; Tomography, X-Ray Computed; Treatment Outcome; Tumors; Vision Disorders - etiology; Young Adult
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.02.020

Abstract Objective This study aimed to better determine the salient signs and symptoms for diagnosis of a pituitary abscess as well as the determination of the most appropriate treatment. Methods A retrospective analysis was performed using clinical presentations, imaging features, diagnosis and treatment of 29 patients with pituitary abscess in our hospital. Results We made the correct diagnosis of pituitary abscess before surgery only in 2 cases (13.3%) out of 15 patients between January 2004 and January 2008. While 12 cases (85.7%) out of 14 patients were correctly diagnosed before surgery between January 2008 and June 2010. All of the patients underwent transnasal–transsphenoidal surgery assisted by the microscope or endoscope. The antibiotic therapy and hormonal replacement were routinely administrated. The postoperative courses were uneventful and all symptoms of the patients were gradually improved one week to six months after surgery. None of the 29 cases were recurrent during the follow-up. Conclusion With the increased clinical experience, the correct diagnosis rate of pituitary abscess before surgery has been greatly improved in recent three years. The microsurgical drainage, proper antibiotics and hormonal replacement are the keys to the treatment of pituitary abscess.