Sphenoid sinus aspergilloma in trans-sphenoidal surgery for pituitary adenomas

Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery

(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.

Isolated invasive fungal sphenoid sinusitis-induced extensive bone erosion and severe meningoencephalitis: diagnosis and multidisciplinary management

Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis has usually a good prognosis, IFS is a potentially lethal condition.We report the case of a woman in her 60s presenting an isolated fungal infection by Aspergillus fumigatus of the right sphenoid sinus, causing extensive bone erosion of its walls and complicated by severe meningoencephalitis. She was healthy without any immunosuppressive conditions. Methods of diagnosis, multidisciplinary management, follow-up and outcomes are documented.Early-stage diagnosis of sphenoid sinus pathologies is often delayed because patients are usually asymptomatic. IFS of the sphenoid is more aggressive than other paranasal sinus and carries significant mortality. Early diagnosis and aggressive and multidisciplinary treatment are crucial to reduce sequels and improve patient's survival.

Aspergillus sphenoiditis growth on long cut ends of a non-absorbable sellar floor dura closure suture

Background:

Cerebrospinal fluid (CSF) rhinorrhea is a common complication after transsphenoidal surgery (TSS). Suturing of sellar dura is effective in the prevention of postoperative CSF rhinorrhea, but it may cause rare postoperative infections. Herein, we report a case of Aspergillus sphenoiditis with the growth noted on cut ends of a polyvinylidene fluoride (PVDF) suture used for dural closure.

Case Description:

A previously healthy 51-year-old woman complained of abnormal odor 5 years after TSS for null cell adenoma. A white mass in the sphenoidal sinus was detected on rhinoscopy. Fungal balls were found clustered around the ends of a PVDF suture used for dural closure at the initial surgery. She underwent removal of both the fungal ball and dural suture. The pathological diagnosis was Aspergillus hyphae. It is thought that a dural suture protruding out of the sphenoid sinus mucosa can cause Aspergillus infection even in immunocompetent patients. A rapid and accurate diagnosis followed by surgical removal of the fungal ball and follow-up with oral antimycotic drugs result in good clinical outcomes.

Conclusion:

It is crucial to cut short the suture end and cover it with sphenoid sinus mucosa to avoid such complications.