Pediatric Sellar-Suprasellar Tubercular Abscess:A Case Report and Literature Review

Abstract

Abstract: Sellar-suprasellar tuberculoma represents 1% of all intracranial tuberculomas, which can convert into a pituitary abscess. Objectives: This paper aims to present a case of a common lesion in an uncommon site,discuss the challenges in diagnosis in terms of clinical manifestations, imaging and histologic findings, discuss aholistic approach to treatment,and enumerate identified clinical outcomes of reported cases in literature. Methodology: This paper presents a case report of a sellar-suprasellar tubercular abscess,and reviews similar cases reported in literature. Results: This is acase of a 16-year old female, Filipino, presenting with a chronic history of intermittent headache, fever, blurring of peripheral vision, polyuria, and increased sleeping time. On neurologic examination, the patient had bitemporal hemianopsia and decreased visual acuity on the right eye. Neuroimaging revealed a hypodense lesion at the sellar-suprasellar area with rim-enhancement on CT and MRI, and laboratory findings suggestive of panhypopituitarism. She underwent Right Pterional Craniotomy and intraoperatively there was note of a firm, yellowish capsule with intracapsular yellowish viscous fluid, which was positive for acid fast bacilli. Marsupialization of abscess was performed and hormonal replacement and anti-tubercular medications were given. Conclusion: Tuberculoma in the sellar-suprasellar area, can impinge on the optic chiasm, producing bitemporal hemianopsia and pituitary dysfunction.It presents like other sellar-suprasellar masses with non-specific symptoms and these masses share similar features on cranial CT scan. Due to the complexity of the disease, treatment of sellar-suprasellar TB requires integrated management of an infectious disease expert, neurologist, neurosurgeon, endocrinologist, and adolescent medicine specialist. Outcomes of four other cases found in literature were generally good after aspiration or drainage of the abscess followed by TB treatment for 15 to 18 months with resulting improvement invision, marked reduction in the size or complete resolution of the mass, but with one case having loss of pituitary function.