Cerebral Vasospasm after Transsphenoidal Surgery for Pituitary Adenoma: A Very Rare but Fatal Complication

Background Vasospasm is a known complication of aneurysmal subarachnoid hemorrhage and is a major cause of neurological morbidity and mortality. Only 51 cases are described associated with pituitary adenoma surgery.

Methods We report two cases and present a systematic review of the literature with a view toward guiding surgeons in the prevention and management of this complication.

Results Including our experience, vasospasm complicating pituitary adenoma surgery has been documented previously only in 53 patients. All cases occurred in the setting of a postoperative hemorrhage usually in postoperative day 6. Initial clinical appearance of delayed cerebral ischemia attributable to vasospasm occurred from postoperative days 2 to 13 (most commonly day 5). Digital subtraction angiography and medical management were the most common diagnostic and therapeutic strategies, respectively. Glasgow’s outcome scores were ≤3 in 59% of cases. Most of patients died in this condition.

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. There is a high rate of death associated with this condition.