Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-24T02:05:32.038Z Has data issue: false hasContentIssue false
  • English
  • Français

Vasospasm Post Pituitary Surgery: Systematic Review and 3 Case Presentations

Published online by Cambridge University Press:  02 December 2014

Alireza Mansouri ,
Aria Fallah ,
Michael D. Cusimano  and
Sunit Das
Alireza Mansouri*
Affiliation:
Division of Neurosurgery, University of Toronto
Aria Fallah
Affiliation:
Division of Neurosurgery, University of Toronto
Michael D. Cusimano
Affiliation:
Division of Neurosurgery, University of Toronto Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Sunit Das
Affiliation:
Division of Neurosurgery, University of Toronto Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
*
St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Email: alireza.mansouri@utoronto.ca
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Vasospasm is a known complication of aneurysmal subarachnoid hemorrhage and is a major cause of neurological morbidity and mortality. It is infrequently associated with pituitary adenoma surgery. We report three cases and present a systematic review of the literature with a view towards guiding neurosurgeons in the prevention and management of this complication.

Results:

Including our experience, vasospasm complicating pituitary adenoma surgery has been documented in 29 patients (mean age of 45). All cases occurred in the setting of a postoperative hemorrhage: 21 had a subarachnoid hemorrhage and 10 had a postoperative hematoma requiring evacuation. Initial clinical appearance of delayed cerebral ischemia attributable to vasospasm occurred from postoperative Days 2-13 (most commonly Day 5). Digital subtraction angiography and medical management were the most common diagnostic and therapeutic strategies, respectively. Glasgow Outcome Scores were ≤3 in 59% of cases. Univariate logistic regression identified later diagnosis of vasospasm and surgery for hematoma evacuation to be independently associated with better outcomes.

Conclusion:

Vasospasm should be considered in the differential diagnosis of patients demonstrating altered mental or neurological status following pituitary surgery, particularly if there has been postoperative hemorrhage of any degree. Prompt treatment should be instituted to optimize outcome.

Résumé

RÉSUMÉContexte:

Le vasospasme est une complication bien connue de l'hémorragie sous-arachnoïdienne anévrismale et constitue une cause majeure de morbidité neurologique et de mortalité. Il est rarement associé à la chirurgie de l'adénome pituitaire. Nous rapportons 3 observations et nous présentons une revue systématique de la littérature dans l'intention de guider les neurochirurgiens concernant la prévention et le traitement de cette complication.

Résultats:

Le vasospasme comme complication de la chirurgie pour un adénome pituitaire a été documenté chez 29 patients (âge moyen 45 ans), incluant nos observations cliniques. Toutes ces complications sont survenues dans le cadre d'une hémorragie postopératoire: 21 hémorragies sous-arachnoïdiennes et 10 hématomes postopératoires nécessitant une évacuation de l'hématome. Au point de vue clinique, une ischémie cérébrale retardée attribuable au vasospasme a été observée entre le 2e jour et le 13e jour après la chirurgie (le plus souvent au 5e jour). L'angiographie digitale de soustraction et le traitement médical ont été les stratégies diagnostique et thérapeutique les plus fréquemment utilisées. Le score de Galsgow Outcome Scale était de s 3 chez 59 % des patients. L'analyse de régression logistique univariée a montré qu'un diagnostic subséquent de vasospasme et une chirurgie pour évacuation d'un hématome étaient associés de façon indépendante à de meilleurs résultats.

Conclusion:

Le vasospasme devrait être inclus dans le diagnostic différentiel de patients dont l'état mental ou l'état neurologique est altéré après la chirurgie pituitaire, particulièrement s'ils ont présenté une hémorragie postopératoire, quelle qu'en soit l'importance. Un traitement rapide devrait être institué afm d'optimiser le résultat.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 767 - 773
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1. Abbott, J, Kirkby, GR. Acute visual loss and pituitary apoplexy after surgery. BMJ. 2004 Jul 24;329(7459):218–19.Google Scholar
2. Jane, JA Jr, Laws, ER Jr. Surgical management of pituitary adenomas. Singapore Med J. 2002 Jun;43(6):318–23.Google Scholar
3. Barzaghi, LR, Losa, M, Giovanelli, M, Mortini, P. Complications of transsphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochirurgica. 2007;149 (9):877–85; discussion 85-6.Google Scholar
4. Raymond, J, Hardy, J, Czepko, R, Roy, D. Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment. AJNR Am J Neuroradiol. 1997 Apr;18 (4):655–65.Google ScholarPubMed
5. Friedman, JA, Meyer, FB, Wetjen, NM, Nichols, DA. Balloon angioplasty to treat vasospasm after transsphenoidal surgery. Case illustration. J Neurosurg. 2001 Aug;95(2):353.Google ScholarPubMed
6. Nishioka, H, Ito, H, Haraoka, J. Cerebral vasospasm following transsphenoidal removal of a pituitary adenoma. Br J Neurosurg. 2001 Feb;15(1):44–7.Google Scholar
7. Zada, G, Du, R, Laws, ER Jr. Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy. J Neurosurg. 2011 Feb; 114(2):286–300.Google Scholar
8. Mawk, JR, Ausman, JI, Erickson, DL, Maxwell, RE. Vasospasm following transcranial removal of large pituitary adenomas. Report of three cases. J Neurosurg. 1979 Feb;50(2):229–32.Google ScholarPubMed
9. Krayenbuhl, H. Beitrag zur Frage des cerebralen angiospastischen Insultes. Schweiz Med Wochenschr. 1960;90:961–5.Google Scholar
10. Hyde-Rowan, MD, Roessmann, U, Brodkey, JS. Vasospasm following transsphenoidal tumor removal associated with the arterial changes of oral contraception. Surg Neurol. 1983 Aug;20 (2):120–4.Google Scholar
11. Popugaev, KA, Savin, IA, Lubnin, AU, et al. Unusual cause of cerebral vasospasm after pituitary surgery. Neurol Sci. 2011 Aug;32(4):673–80.Google Scholar
12. Cervoni, L, Salvati, M, Santoro, A. Vasospasm following tumor removal: report of 5 cases. Ital J Neurol Sci. 1996 Aug;17(4):291–4.CrossRefGoogle ScholarPubMed
13. Camp, PE, Paxton, HD, Buchan, GC, Gahbauer, H. Vasospasm after trans-sphenoidal hypophysectomy. Neurosurgery. 1980 Oct;7(4): 382–6.CrossRefGoogle ScholarPubMed
14. Aoki, N, Origitano, TC, al-Mefty, O. Vasospasm after resection of skull base tumors. Acta Neurochirurgica. 1995;132(1-3):53–8.Google Scholar
15. Barrow, DL, Tindall, GT. Loss of vision after transsphenoidal surgery. Neurosurgery. 1990 Jul;27(1):60–8.Google Scholar
16. Puri, AZ, Zarzour, G, Laws, EH. Frerichs, K. Symptomatic cerebral vasospasm after trans-sphenoidal resection of pituitary macroadenomas. J Neurointerv Surg. 2010;2(S1):A37.Google Scholar
17. Ono, MM, Nukui, H. Kawafuchi, J. Vasospasm following removal of a large pituitary adenoma by the subfrontal approach. Report of a case and review of the literature. Neurologica Medico-Chirurgica. 1981;21(6):609–14.Google Scholar
18. Tsunoda, MOT, Kuramae, H, Takagi, H, Nakamura, N, Miyasaka, Y. Two cases of cerebral angiospasm after removal of pituitary tumor. 7. Tokyo: Neuron Co; 1972; 7–17.Google Scholar
19. Takao, A WY, Kameda, H, Tsunami, M, Satoh, K, Ueda, H MT. A case complicated with severe vasospasm after total removal of a pituitary tumor. Rinshoshinkei. 1979;19:772.Google Scholar
20. Kasliwal, MK, Srivastava, R, Sinha, S, Kale, SS, Sharma, BS. Vasospasm after transsphenoidal pituitary surgery: a case report and review of the literature. Neurology India. 2008 Jan-Mar;56 (1):81–3.Google Scholar
21. Mawk, JR. Vasospasm after pituitary surgery. J Neurosurg. 1980;58:972.Google Scholar
22. Kassell, NF, Kongable, GL, Torner, JC, Adams, HP Jr, Mazuz, H. Delay in referral of patients with ruptured aneurysms to neurosurgical attention. Stroke. 1985 Jul-Aug;16(4):587–90.Google Scholar
23. Kassell, NF, Torner, JC, Haley, EC Jr, Jane, JA, Adams, HP, Kongable, GL. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990 Jul;73(1):18–36.Google Scholar
24. LeRoux, PD, Haglund, MM, Mayberg, MR, Winn, HR. Symptomatic cerebral vasospasm following tumor resection: report of two cases. Surg Neurol. 1991 Jul;36(1):25–31.Google Scholar
25. MacDonald, RL. Cerebral Vasospasm. San Diego, California: Academic Press; 2001.Google Scholar
26. MacDonald, RL. Management of cerebral vasospasm. Neurosurgical Rev. 2006;29:179–93.Google Scholar
27. Sen, J, Belli, A, Albon, H, Morgan, L, Petzold, A, Kitchen, N. Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage. Lancet Neurol. 2003;2(10):614–20.Google Scholar
28. Laws, ER. Vascular complications of transsphenoidal surgery. Pituitary. 1999;2(2):163–70.Google Scholar
29. Wilson, JL, Field, JR. The production of intracranial vascular spasm by hypothalamic extract. J Neurosurg. 1974;40:473–9.Google Scholar
30. Anderson, GB, Findlay, JM. CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. Am J Neuroradiol. 2000;21:1011–15.Google Scholar
31. Tamatani, S, Fujii, Y, Koike, T, Tanaka, R. Detection of delayed cerebral vasospasm, after rupture of intracranial aneurysms, by magnetic resonance angiography (comment). Neurosurgery. 1997;40:748–53.CrossRefGoogle Scholar