Primary Sellar Abscesses: A Systematic Review and 2 Rare Observations

Background Abscesses of the chiasmatic-sellar region are quite rare and are often a result of surgical intervention, trauma, or tumor growth. Primary abscesses are extremely rare and represent a group of abscesses the occur because of internal microbial seeding. Primary abscesses are rarely reported. We present 2 clinical cases featuring primary abscesses of the chiasmal-sellar region. To put into perspective the rarity of these findings, we performed a systematic review of existing clinical reports regarding this pathology. Methods A systematic review of literature was conducted to gather existing clinical reports on primary abscesses of the chiasmatic-sellar region. Two personal findings are added to the literature review, including a 13-year-old girl and a 58-year-old man who presented with chiasmal-sellar region primary abscesses. The diagnostic aspects, treatment strategy, and outcomes are discussed. Results Both patients included in the report had positive outcome. The pediatric patient developed a recurrence of the abscess and was treated accordingly. Overall, 41 cases of primary abscesses of this region have been reported in literature, of which 6 are in children under 18 years of age. The main nonspecific clinical manifestations include headaches, visual impairment, and endocrine pathology. Acute inflammatory responses are rarely seen, despite infectious genesis. Transnasal endoscopic surgical treatment offers diagnostic and treatment advantages. Conclusions Proper diagnostic procedures can aid in correct treatment strategy and improve overall outcome.