Intrasellar abscess following transsphenoidal surgery.

BACKGROUND: Intrasellar abscess following transsphenoidal surgery has been described only twice in the English language medical literature. Overall mortality associated with intrasellar abscesses is 51%, while mortality in reported cases not treated surgically is 100%. METHODS: Two cases of intrasellar abscess following uncomplicated transsphenoidal surgery for pituitary pathology are reported. The incidence, radiographic features, clinical presentations, and treatment of intrasellar abscesses are discussed. RESULTS: Both patients described underwent uncomplicated transsphenoidal procedures for treatment of a primary pituitary lesion. Neither developed postoperative CSF rhinorrhea, and initial recovery was uneventful. The first patient presented with new symptoms several weeks after transsphenoidal surgery; the second patient almost two years postoperatively. The first displayed signs of an expanding sellar mass, requiring transsphenoidal drainage and postoperative antibiotics. The second presented with recurrent meningitis without discernible CSF leak, and was treated with transnasal endoscopic drainage in conjunction with antibiotic therapy. CONCLUSIONS: The high mortality associated with intrasellar abscess mandates its inclusion in the differential diagnosis of patients presenting with symptoms of meningitis or an expanding sellar mass after transsphenoidal intervention. Although antibiotic therapy is an important adjunct, surgical drainage is required for definitive treatment.

MRI of esthesioneuroblastoma.

OBJECTIVE: Esthesioneuroblastomas are uncommon tumors originating in the olfactory epithelium of the superior nasal cavity. Accurate staging appropriately guides therapy and predicts survival. The MR appearance and pattern of contrast enhancement in these tumors have not been well described. The goals of this article were to analyze the MRI characteristics of esthesioneuroblastoma, including extent of tumor, differentiation from obstructive sinus disease, MR signal, and pattern of contrast enhancement. MATERIALS AND METHODS: The MR examinations of six patients with proven advanced esthesioneuroblastoma were reviewed. Standard SE T1- and T2-weighted axial images were obtained [550-600/15-25 and 2,000-2,760/80-90 (TR/TE), respectively], followed by postcontrast axial and coronal T1-weighted sequences in all patients. RESULTS: Five of the six tumors were centered in the superior nasal cavity and one was centered in the lateral ethmoid air cells. Five tumors extended intracranially. Postobstructive sinus disease was always encountered. As compared to gray matter, the signal on T1-weighted images was either hypo- or isointense. On T2-weighted images, the signal varied from iso- to hyperintensity. Contrast enhancement was intense and of variable uniformity. CONCLUSION: Magnetic resonance signal characteristics helped to distinguish obstructive sinus disease from tumor. The MR signal characteristics and pattern of contrast enhancement were nonspecific for esthesioneuroblastoma. Enhanced images, particularly in the coronal plane, were very helpful in identifying intracranial extension.