Abstract
Symptomatic cerebral vasospasm (CVS) after transsphenoidal surgery (TSS) is very rare compared with vasospasm resulting from aneurysmal subarachnoid hemorrhage (SAH). Fewer than six cases documented by cerebral angiography have been reported. We evaluated the records of 15 patients in whom SAH developed after TSS. Their clinical symptoms, radiological and laboratory findings were analyzed. Among 15 patients with postoperative SAH, 11 did not show CVS during their postoperative course. However, four patients presented with various clinical symptoms suggestive of CVS on postoperative days 7–9. They showed an abrupt drop of serum sodium level 1 or 2 days before the onset of CVS symptoms. Patients with TSS-related SAH should be managed with proactive and aggressive treatment. Hyponatremia, which usually occurs around the first week after TSS, should not be ignored as a matter of metabolic or hormonal disequilibrium commonly encountered after pituitary surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Camp PE, Paxton HD, Buchan GC, Gahbauer H (1980) Vasospasm after trans-sphenoidal hypophysectomy. Neurosurgery 7(4):382–386
Hyde-Rowan MD, Roessmann U, Brodkey JS (1983) Vasospasm following transsphenoidal tumor removal associated with the arterial changes of oral contraception. Surg Neurol 20(2):120–124
Friedman JA, Meyer FB, Wetjen NM, Nichols DA (2001) Balloon angioplasty to treat vasospasm after transsphenoidal surgery. Case illustration. J Neurosurg 95(2):353
Nishioka H, Ito H, Haraoka J (2001) Cerebral vasospasm following transsphenoidal removal of a pituitary adenoma. Br J Neurosurg 15(1):44–47
Kasliwal MK, Srivastava R, Sinha S, Kale SS, Sharma BS (2008) Vasospasm after transsphenoidal pituitary surgery: a case report and review of the literature. Neurol India 56(1):81–83
Fisher C, Kistler J, Davis J (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6(1):1–9
Wilson CB (1984) A decade of pituitary microsurgery. J Neurosurg 61:814–833
Popugaev KA, Savin IA, Lubnin AU, Goriachev AS, Kadashev BA, Kalinin PL, Pronin IN, Oshorov AV, Kutin MA (2011) Unusual cause of cerebral vasospasm after pituitary surgery. Neurol Sci 32(4):673–680
Agrawal D, Mahapatra AK (2005) Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surg Neurol 63(1):42–46 (discussion 46)
Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2):225–236 (discussion 236–237)
Bejjani GK, Sekhar LN, Yost AM, Bank WO, Wright DC (1999) Vasospasm after cranial base tumor resection: pathogenesis, diagnosis, and therapy. Surg Neurol 52(6):577–583 (discussion 583–584)
Mawk JR, Ausman JI, Erickson DL, Maxwell RE (1979) Vasospasm following transcranial removal of large pituitary adenomas. Report of three cases. J Neurosurg 50(2):229–232
Aoki N, Origitano TC, al-Mefty O (1995) Vasospasm after resection of skull base tumors. Acta Neurochir (Wien) 132(1–3):53–58
Asano T (1999) Oxyhemoglobin as the principal cause of cerebral vasospasm: a holistic view of its actions. Crit Rev Neurosurg 9:303–318
Hansen-Schwartz J (2004) Cerebral vasospasm: a consideration of the various cellular mechanisms involved in the pathophysiology. Neurocrit Care 1:235–246
Provencio JJ, Vora N (2005) Subarachnoid hemorrhage and inflammation: bench to bedside and back. Semin Neurol 25:435–444
Oh MC, Kim EH, Kim SH (2012) Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma. J Neurosurg 116(5):942–947
Sherlock M, O’Sullivan E, Agha A, Behan LA, Rawluk D, Brennan P, Tormey W, Thompson CJ (2006) The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol (Oxf) 64(3):250–254
Wijdicks EF, Vermeulen M, Hijdra A, van Gijn J (1985) Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol 17(2):137–140
Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, Guterman LR, Hopkins LN (2002) Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 50(4):749–755 (discussion 755–756)
Chandy D, Sy R, Aronow WS, Lee WN, Maguire G, Murali R (2006) Hyponatremia and cerebrovascular spasm in aneurysmal subarachnoid hemorrhage. Neurol India 54(3):273–275
McGirt MJ, Blessing R, Nimjee SM, Friedman AH, Alexander MJ, Laskowitz DT, Lynch JR (2004) Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery 54(6):1369–1373 (discussion 1373–1374)
Wu CT, Wong CS, Yeh CC, Borel CO (2004) Treatment of cerebral vasospasm after subarachnoid hemorrhage–a review. Acta Anaesthesiol Taiwan 42(4):215–222
Zada G, Liu CY, Fishback D, Singer PA, Weiss MH (2007) Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery. J Neurosurg 106(1):66–71
Sata A, Hizuka N, Kawamata T, Hori T, Takano K (2006) Hyponatremia after transsphenoidal surgery for hypothalamo-pituitary tumors. Neuroendocrinology 83(2):117–122
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Eui Hyun Kim and Min Chul Oh contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kim, E.H., Oh, M.C. & Kim, S.H. Angiographically documented cerebral vasospasm following transsphenoidal surgery for pituitary tumors. Pituitary 16, 260–269 (2013). https://doi.org/10.1007/s11102-012-0415-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-012-0415-7