Remote extradural hematoma as a complication of endoscopic transsphenoidal surgery: A case report with literature review

Introduction: The sellar region is one of the most areas to access in skull base surgery. The endoscopic transsphenoidal approach is a minimally invasive technique developed to create a clear trajectory to the sellar region through the sellar floor. Conversely, this area is surrounded by major intracranial vessels and multiple cranial nerves, hence, every surgical procedure to access this area carries dangerous complications, including hematoma. Remote extradural hematoma is an extremely rare complication following the endoscopic transsphenoidal approach, and the pathogenesis has not been elucidated. Case presentation: This study reported a case of 38-years old female suffered from chronic cephalgia and bilateral vision loss since one year ago. Further neuroimaging examination showed solid extra-axial mass, suggesting pituitary adenoma. Laboratory result showed increased Prolactin (216,2 ng/dl) with no other hormonal disturbance. Urgent endoscopic transsphenoidal surgery was planned to excise the tumor. Post-operative CT showed acute right frontal extradural hematoma, in which the patient was planned to have immediate surgery afterwards. Discussion: The specific mechanism of developing EDH post-surgery is unknown because it is an unusual consequence of endoscopic transsphenoidal surgery. Rapid CSF draining during surgery may have led to the formation of a remote extradural hematoma in our patient. Conclusion: Endoscopic transsphenoidal surgery also carries the potential risk of remote extradural hematoma, careful steps must be taken to prevent this serious complication during transsphenoidal surgery.