Abstract
Background Cerebral ischemic complications after pituitary surgery are not frequently reported.
These vascular complications may be related to (1) direct trauma to the vessel wall,
(2) compression of the internal carotid artery (ICA) due to pituitary apoplexy, (3)
vasospasm secondary to subarachnoid hemorrhage or vasoactive tumor extract, or (4)
hypothalamic injury.
Patients We describe two cases where major vessel infarcts occurred after removal of pituitary
tumor. One case has repeated episodes of thrombembolism probably due to a internal
carotid artery (ICA) dissection triggered by minor intraoperative ICA injury during
transsphenoidal excision. The other cases had a late-onset cerebral ischemia due vasospasm
of middle cerebral artery after transcranial excision of a large pituitary tumor.
Result Both patients had a long hospital stay and were managed successfully with anticoagulant
and antiplatelet drugs, aggressive supportive care in the intensive care unit, and
rehabilitation.
Conclusion These cases highlight two different mechanisms of infarcts after pituitary surgery.
The first case highlights the importance of ICA evaluation before surgery in elderly
patients with risk factors, such as chronic smoking, hypertension, and atherosclerotic
disease. Even minimal manipulation of the ICA can generate a cascade of thrombembolic
events in such patients. The second case highlights the importance of observing the
patient of a highly vascular giant pituitary adenoma in the hospital for a longer
than usual time. Delayed vasospasm can occur like in aneurysmal subarachnoid hemorrhage
and have a good outcome if detected early and managed judiciously.
Keywords
pituitary surgery - carotid artery dissection - vasospasm - transsphenoidal surgery
- infarct
