J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e119-e123
DOI: 10.1055/s-0032-1328955
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Ischemic Complications after Pituitary Surgery: a Report of Two Cases

Rahul Gupta
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, New Delhi, India
,
Arun Sharma
1   Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, New Delhi, India
,
Richa Vaishya
2   Department of Biochemistry, G. B. Pant Hospital, University of Delhi, New Delhi, India
,
Monica Tandon
3   Department of Anaesthesiology, G. B. Pant Hospital, University of Delhi, New Delhi, India
› Author Affiliations
Further Information

Publication History

28 January 2012

01 July 2012

Publication Date:
07 September 2013 (online)

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.

 
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