Vasospasm following transcranial removal of large pituitary adenomas

Abstract

The authors report three cases of cerebral vascular spasm following transfrontal removal of large pituitary neoplasms. One patient awakened from surgery hemiparetic, but has since recovered. A second patient developed hemiparesis with confusion on the fifth postoperative day and eventually died. The third patient developed hemiplegia on the tenth postoperative day, but recovered completely. Vascular spasm was documented angiographically in all three cases. Possible mechanisms underlying this unusual complication are discussed.

A case of fatal late vasospasm in a patient with a recurrent, supratentorial, rhabdoid primitive neuroectodermal tumor: possible molecular implications.

“…Others hypothesized that vasospasm could be caused by the placement of gel foam in the tumor bed at the time of surgery and an imbalance of vascular tone that resulted from the stress of surgery (4,5,17).…”

“…Unfortunately, this is only a hypothesis based on clinical and immunohistochemical data, and further studies to understand this rare but potentially fatal phenomenon should be attempted (3,17).…”

“…Nevertheless, a burgeoning body of evidence has suggested that various constituents of the inflammatory response, including adhesion molecules, cytokines, leukocytes, immunoglobulins, and complement, may be critical in the pathogenesis of cerebral vasospasm (8,17). Vasoactive…”

“…The diffusion of these substances into the basal subarachnoid spaces might lead to a vasospasm (3,17).…”

Diffuse Cerebral Vasospasm After Resection of a Posterior Fossa Ependymoma

“…In the last several years, there have been an increasing number of cases of symptomatic cerebral vasospasm following intracranial tumor resection [1][2][3][4][5][6][7][8][9][10]. Recognition of these cases is difficult because some of the manifestations may be attributed to residual post-operative swelling.…”