Unusual Presentation of Vasospasm Masking Underlying Pseudoaneurysm After Endoscopic Transsphenoidal Surgery in Pituitary Macroadenoma

Cerebral vasospasm occurring immediately after endoscopic transsphenoidal resection of a pituitary adenoma: A case report

“…[1,4] Several pathogenic mechanisms for cerebral vasospasms have been proposed, such as direct vascular injury and damage to the arachnoid layer leading to the leakage of blood into the subarachnoid layer, cerebrospinal fluid rhinorrhea, and meningitis. [1,2,5] However, a clear mechanism has yet to be established. Popugaev et al reported on two cases of cerebral vasospasm that presented with meningitis within a month after transsphenoidal pituitary adenoma surgery.…”

“…[1,4] Induced hypertension, euvolemia maintenance, and nimodipine administration are reported to be effective treatment options in patients who have made complete neurologic recovery. [1][2][3][4] It has also been reported that appropriate transfusion management was used in the treatment of cerebral vasospasm with meningitis. [5] Our patient was treated using the same principles as the management of vasospasm in aneurysmal subarachnoid hemorrhage.…”

Cerebral vasospasm as a consequence of pituitary apoplexy: illustrative case

“…1,10,13,14 Current research indicated that subarachnoid blood and its components in the cisterns are contributors to cerebral vasospasm. [15][16][17][18][19] Moreover, the presence of free radicals such as the degradation products of hemoglobin (oxyhemoglobin and methemoglobin), as well as the release of vasoactive products from the tumor, was likely to cause vasospasm. 12,20 It was also reported that those products might be responsible for the inflammatory responses that led to decreased nitric oxide levels in the endothelia, which ultimately decreased the blood vessel diameter.…”

“…1,2,4,[6][7][8][9][10]12,21,23,[26][27][28][29] Only 8 out of the 25 reviewed pituitary adenoma cases underwent EETS (Table 1). 1,2,10,[12][13][14][15] Half of these patients were female (4 of 8; 50%). The mean age was 50 years (standard deviation ±17, range .…”

“…13 In cases where neither CTA nor MRA indicates the presence of cerebral vasospasm but clinical evidence suggests otherwise (i.e., neurological deterioration), cerebral angiography is recommended in an attempt to rule out cerebral vasospasm, because delayed diagnosis will likely worsen the outcome. [13][14][15] Management of cerebral vasospasm following pituitary apoplexy has been done mostly via induced hypertension and euvolemia in addition to the administration of vasodilators such as verapamil and nimodipine. 10,12 Endovascular treatment (balloon angioplasty) was used in more severe cases.…”