Reoperation for sella haematoma after pituitary surgery

Objective: Although occasionally discussed as a general complication in large pituitary series, the incidence of reoperation for postoperative sella haematoma is unclear. We retrospectively reviewed a large pituitary surgical series to determine the incidence and associated factors of this complication. Design: We reviewed all pituitary surgery at Mayo Rochester from January 1987 until January 2007. There were 2312 transsphenoidal procedures during this period. Patients: All patients had proven pituitary pathology by computed tomography (CT) or magnetic resonance imaging and pituitary function studies. Measurements: Reoperation for sella haematoma and perioperative clinical correlations were the only measurement tools. It is indeterminate how many patients had postoperative sella haematoma without visual loss because routine postoperative CT scanning was not performed. Results: Three patients underwent reoperation for postoperative haematoma in the sella by three different endocrine neurosurgeons, and all three patients had progressive postoperative visual loss. All initial operations were for large macroadenomas; two had early postoperative hypertension that may have been a contributor; and one had markedly thickened bone felt to be the source of bleeding and deterioration 24 h later. Conclusions: Reoperation for postoperative sellar haematoma is uncommon. However, postoperative progressive visual loss was clinically present in all three patients, and labile hypertension postoperatively may play a role.