Walsh & Hoyt: Pituitary Abscess

Abscesses in the sella do not necessarily present with signs and symptoms of infection; most are discovered when the surgeon encounters a pus-filled cyst. The material aspirated may be sterile, but bacterial genera identified include Staphylococcus, Streptococcus, Neisseria, Corynebacteria, diphtheroids, and even Brucella. As noted, fungal and parasitic abscesses also occur. Sphenoid mucoceles containing bacteria may extend into the sella and mimic pituitary adenoma and other parasellar processes. Late-developing sphenoid mucoceles are a complication of transsphenoidal surgery and must be included in the differential diagnosis of visual loss and ophthalmoplegia presenting years after surgical treatment of adenoma.