Cavernous Sinus Syndrome after Endoscopic Transsphenoidal Pituitary Surgery with Successful Early Decompression and Postoperative Course

Abstract

Cavernous sinus syndrome is rare complication of transsphenoidal endoscopic pituitary surgery. We present the case of a 65-year-old male with a history of hypertension and obesity, who presented 2 years of decreased visual acuity and bitemporal hemianopsia. The brain CT scan and contrast-enhanced MRI revealed a pituitary macroadenoma with grade II Knosp classification on the left side, the hormonal tests were normal. The computerized visual fields showed a severe bilateral vision compromise in all quadrants, predominantly bitemporal hemianopia. A non-functioning pituitary macroadenoma was diagnosed. The patient underwent a transsphenoidal endoscopic resection with no complications during the procedure and had an uneventful early postoperative course, nevertheless 72 hours after he presented with III, IV, and VI cranial nerve palsy, progressive left visual impairment and mild alteration in his mental status. Brain CT scan and MRI revealed a predominantly suprasellar large fat graft with hemostatic material, without any bleeding or infarct. Emergent transsphenoidal endoscopic decompression and a new multilayered closure were performed. In this postoperative period, the patient improved all the signs compatible with cavernous sinus syndrome, in addition to having adequate recovery and being able to be discharged after 5 days. In late follow-up, the patient partially recovered his vision objectively evidenced in the computerized visual fields and did not develop hormonal disorders. This is the first report that describes an acute cavernous sinus syndrome after a transsphenoidal endoscopic pituitary surgery for a macroadenoma resection with successful early decompression and postoperative course.