J Rhinol.  2005 Nov;12(2):120-123.

A Case of Blindness after Transsphenoid Approach for Pituitary Adenoma Removal: Revision Treatment Experience under Local Anesthesia

• Park HJ
• Lim JW
• Lim YH
• Rho YS

Abstract

Pituitary adenoma accounts for 10% to 20% of intracranial tumors. Surgical approach to pituitary adenoma had been performed via craniotomy until the early 20th century, but transsphenoidal approach has been accepted as a primary procedure since 1910. However, there are frequent complications in the nose including nasal mucosal laceration, nasal septal perforation, and external nose deformities. Furthermore, cerebrospinal fluid leakage, visual field loss or blindness rarely occur. When blindness occurs by postoperative hematoma compression, revision operation is usually required for bleeding control and hematoma removal under general anesthesia. However, optic nerve decompression with postoperative hematoma removal via transsphenoidal approach can be adequately performed by endoscopic technique under local anesthesia, because there is no sensory nerve innervation in the pia mater and arachnoid membrane. We report a case of successful hematoma removal with bleeding control by endoscopic technique under local anesthesia in a patient who became blind due to postoperative hematoma after transphenoid approach for pituitary adenoma removal.

Keyword

Transsphenoidal surgery; Pituitary disease; Local anesthesia; Complications

MeSH Terms

Anesthesia, General
Anesthesia, Local*
Arachnoid
Blindness*
Cerebrospinal Fluid
Congenital Abnormalities
Craniotomy
Decompression
Hematoma
Hemorrhage
Humans
Lacerations
Membranes
Nasal Septal Perforation
Nose
Optic Nerve
Pia Mater
Pituitary Diseases
Pituitary Neoplasms*
Visual Fields