Objective:It was to assess the main characteristics of patients undergoing pituitary tumor surgery.Method:Eighty-seven patients (44 men; 44.8±13 years old) were included.Results:The main symptoms were visual alterations (87.3%), headache (70.1%), diminished libido (34.4%), galactorrhea (22.9%) and hair loss (19.5%). The axes affected were gonadotropic (72.6%), thyrotropic (48.4%) and corticotropic (38.7%), without significant changes after surgery. The average largest tumor diameter was 3.1 cm before surgery and 1.56 cm after surgery. The most frequent postoperative complications were hydro-electrolyte and acid-base disorders (12%), diabetes insipidus (9%), visual field alterations (9%), liquoric fistula (8%) and nasal obstruction (7%). The patients were affected by more than one complication.Conclusion:Although a decrease in tumor volume was achieved through surgery, hormonal deficiencies persisted in most of the patients and new surgical approaches were necessary for dealing with tumor recurrence or persistence.

TAO during ACom aneurysm repair does not seem to add more morbidities to the procedure, and is not an independent prognostic factor.

Cerebral vasospasm and the delayed cerebral ischemia remain a source of substantial morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Hemodynamic manipulation better known as ‘triple H’ therapy is routinely used in the management of patients with acute vasospasmfollowing SAH. The rationale of inducing hypertension, hypervolemia and hemodilution is to improve blood flow to the injured brain and to prevent secondary ischemia. While the Ca2+ antagonist Nimodipine is still the only drug with proven benefit on neurologic outcome following SAH, several alternatives are under research. Tirilazad is not effective, and studies of hemodynamic maneuvers, magnesium, statin medications, endothelin antagonists, steroid drugs, anticoagulant/antiplatelet agents, and intrathecal fibrinolytic drugs have yielded inconclusive and controversial results. Steroids drugs and anticoagulant/antiplatelet agents have been abandoned so far, because of the lack of efficacy. The purpose of the present paper is to provide a systematic review of the existing literature on the treatment of cerebral vasospasm.

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Introduction: This study was undertaken to determine variables that could predict, in the perioperative period of anterior communicating artery (ACom) aneurysms surgeries, the likelihood of postoperative sequelae and complications, after temporary arterial occlusion. Patients and Methods: In a universe of 92 patients submitted to ACom aneurysm clipping between 2000 and 2013, 32 were operated in the last seven years. Among these patients, 21 needed temporary arterial occlusion during surgical aneurysm repair, and had their data examined retrospectively. Results: Aneurysms larger than 7mm were more likely to be treated with longer temporary clipping time than small aneurysms, <7mm (22±5.7 vs 11.3±4.1, t-Test, p <0.0001). There was no statistical correlation between time of occlusion and outcome (r=0.92, Pearson, p>0.08). Age, Glasgow Coma Scale (GCS) at initial evaluation, and Fisher scale at 1st CT scanning were independent factors of unfavorable outcome (Glasgow Outcome Scale ≤ 3) (cox-regression, p<0.001). Among variable factors, patients older than 50 years, an initial GCS under 13, and a Fisher grade III or IV resulted in worse outcome. Meanwhile gender, tobacco or alcohol addiction, obesity, arterial hypertension, dyslipidemia, location of temporary occlusion (A1 or A2), intraoperative rupture and the aneurysm size were not identified as independent prognostic factors. During follow-up period, two thirds of the patients had a favorable outcome (GOS ≥ 4), accomplishing normal daily life activities without major complications. Fifty-two percent of patients evolved with hydrocephalus, despite of routine fenestration of the lamina terminalis, performed in 71.4% of procedures. Most patients also developed clinical vasospasm (66.6%), with 19% of the patients presenting with a severe disease. Delayed ischemic neurological deficit was observed in 28.5%, secondary to severe vasospasm, and without any statistical correlation to time of temporary occlusion or intraoperative aneurysm rupture. Conclusion: Temporary clipping during ACom aneurysm repair does not seem to add more morbidities to the procedure, and is not an independent prognostic factor. However, age, initial GCS and Fisher grade are associated to unfavorable outcome.