Angioplasty is an Effective Treatment for Vasospasm Following Pituitary Apoplexy and Tumor Resection

Abstract

Pituitary apoplexy is a clinical syndrome characterized by acute headache, visual changes, and decreased consciousness occurring in association with hemorrhage or infarct of an existing pituitary adenoma. Surgical management involves tumor resection and decompression of surrounding structures including the optic apparatus. Vasospasm is a rare but potentially devastating complication of pituitary apoplexy. We present a case of pituitary apoplexy in a 28-year-old male treated with emergent endoscopic transsphenoidal resection. On postoperative day seven, following surgical resection, the patient developed neurologic deficits and motor weakness, and severe vasospasm was diagnosed. This is a novel case of intra-arterial verapamil and angioplasty used to treat vasospasm following surgical decompression for pituitary apoplexy. The patient experienced complete recovery of motor deficits following treatment. The authors propose angioplasty as an effective treatment for postoperative vasospasm following transphenoidal surgery for pituitary apoplexy in the presence of focal vessel stenosis.

Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review

“…In addition to the proposed etiologies of vasospasm after tumor resection, hypothalamic injury or electrolyte disturbance can contribute to the risk of vasospasm after TSS [1,5,10,34]. Other proposed risk factors for postresection vasospasm are pituitary apoplexy, intraoperative CSF leak, basal cistern tumor extension, hyponatremia, and postoperative syndrome of inappropriate antidiuretic hormone [35]. Hypothalamic dysfunction can also induce vasospasm by triggering a sympathetic discharge and catecholamine release [36,37].…”