J Korean Neurosurg Soc.  1996 Nov;25(11):2209-2228.

Vasospasm as Severe Complication Following Transcranial Removal of Large Pituitary Adenoma:Clinical Review and Analysis

• Lee CH
• Whang CJ

Abstract

Very few cases of arterial spasm after pituitary surgery have been reported to date. The author analysed 4 patients with vasospasm following transcranial subfrontal removal of pituitary adenoma, which were adimitted to our department and 4 cases were reviewed in the literature. In our 4 cases, the age of the patients varied between 23 to 59 years. There were 2 men and 2 women. Delayed deterioration of consciousness or neurologic deficit was observed in all cases. Two patients recovered completely and two were bed-ridden. Vasospasm was documented by angiogram or transcranial Doppler ultrasonography(TCD, EME, Co.). Possible mechanisms underlying this unusual complication are reviewed and discussed. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials are liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. These agents might then diffuse into the basal cisternal space and interact with blood vessel walls in such a way as to produce vascular spasm.

Keyword

Vasospasm; Pituitary adenoma; Angiogram; Vasoactive materials; Hypothalamus

MeSH Terms

Blood Vessels
Consciousness
Female
Humans
Hypothalamus
Male
Necrosis
Neurologic Manifestations
Pituitary Gland
Pituitary Neoplasms
Spasm