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Peer-reviewedCC BY-NC-ND 4.0Journal of Neurosurgery: Case Lessons

Acute visual deterioration following endoscopic transsphenoidal resection of a pituitary adenoma secondary to a de novo cyst of normal pituitary origin: illustrative case

  • Madelyn Gilbert1
  • Isabel A. Wood1
  • Cristina Hayes Meizoso1
  • Janelle P. Renterghem1
  • Brittany Owusu- Adjei1,2
  • Rrita Daci1,2
  • Thomas W. Smith3
  • Constance J. Mietus1,2
  • Neeraja Konuthula4
  • Peter S. Amenta1,2
4 affiliations
  1. 1Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester
  2. 2Department of Neurological Surgery, University of Massachusetts Memorial Medical Center, Worcester
  3. 3Department of Pathology, University of Massachusetts Chan Medical School, Worcester
  4. 4Department of Otolaryngology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Abstract

BACKGROUND: Pituitary adenomas (PAs) are common benign intracranial neoplasms. Transsphenoidal resection is the standard of care for symptomatic tumors, with surgical complications including CSF leakage, infection, hormonal disturbances, and postoperative hematomas leading to visual decline. Rapid postoperative cyst development leading to acute visual deterioration is a rare but potentially significant complication.

OBSERVATIONS: A 63-year-old female with headaches and pulsatile tinnitus presented with a large PA compressing the optic apparatus. Transsphenoidal surgery (TSS) via an endoscopic endonasal approach was performed. On postoperative day 6, the patient experienced rapid onset of bitemporal hemianopsia, and imaging revealed a new suprasellar cystic lesion. The patient underwent emergency craniotomy for cyst resection, with pathological analysis demonstrating a nonneoplastic anterior pituitary gland. A systematic literature review of rapid cyst formation following TSS yielded only 1 article for inclusion. No cases of a postoperative cyst of normal pituitary gland origin were identified.

LESSONS: Visual decline following TSS is typically due to a sellar/suprasellar hematoma, abscess, or CSF accumulation. Few reports attribute acute postoperative visual deterioration to the development of a secondary pituitary mass, typically due to PA recurrence or formation of a suprasellar cyst. Emergency cyst resection via a transcranial approach resulted in restoration of vision and preservation of pituitary function, supporting aggressive surgical management.

https://thejns.org/doi/10.3171/CASE26459

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Cite

BibTeXRIS
BibTeX
@article{gilbert2026acute,
  title = {{Acute visual deterioration following endoscopic transsphenoidal resection of a pituitary adenoma secondary to a de novo cyst of normal pituitary origin: illustrative case}},
  author = {Madelyn Gilbert and Isabel A. Wood and Cristina Hayes Meizoso and Janelle P. Renterghem and Brittany Owusu- Adjei and Rrita Daci and Thomas W. Smith and Constance J. Mietus and Neeraja Konuthula and Peter S. Amenta},
  journal = {Journal of Neurosurgery: Case Lessons},
  year = {2026},
  month = oct,
  doi = {10.3171/case26459},
  url = {https://doi.org/10.3171/case26459},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Acute visual deterioration following endoscopic transsphenoidal resection of a pituitary adenoma secondary to a de novo cyst of normal pituitary origin: illustrative case
AU  - Madelyn Gilbert
AU  - Isabel A. Wood
AU  - Cristina Hayes Meizoso
AU  - Janelle P. Renterghem
AU  - Brittany Owusu- Adjei
AU  - Rrita Daci
AU  - Thomas W. Smith
AU  - Constance J. Mietus
AU  - Neeraja Konuthula
AU  - Peter S. Amenta
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Neurosurgery: Case Lessons
DO  - 10.3171/case26459
UR  - https://doi.org/10.3171/case26459
AB  - BACKGROUND: Pituitary adenomas (PAs) are common benign intracranial neoplasms. Transsphenoidal resection is the standard of care for symptomatic tumors, with surgical complications including CSF leakage, infection, hormonal disturbances, and postoperative hematomas leading to visual decline. Rapid postoperative cyst development leading to acute visual deterioration is a rare but potentially significant complication.  OBSERVATIONS: A 63-year-old female with headaches and pulsatile tinnitus presented with a large PA compressing the optic apparatus. Transsphenoidal surgery (TSS) via an endoscopic endonasal approach was performed. On postoperative day 6, the patient experienced rapid onset of bitemporal hemianopsia, and imaging revealed a new suprasellar cystic lesion. The patient underwent emergency craniotomy for cyst resection, with pathological analysis demonstrating a nonneoplastic anterior pituitary gland. A systematic literature review of rapid cyst formation following TSS yielded only 1 article for inclusion. No cases of a postoperative cyst of normal pituitary gland origin were identified.  LESSONS: Visual decline following TSS is typically due to a sellar/suprasellar hematoma, abscess, or CSF accumulation. Few reports attribute acute postoperative visual deterioration to the development of a secondary pituitary mass, typically due to PA recurrence or formation of a suprasellar cyst. Emergency cyst resection via a transcranial approach resulted in restoration of vision and preservation of pituitary function, supporting aggressive surgical management.  https://thejns.org/doi/10.3171/CASE26459
SN  - 2694-1902
ER  -