Symptomatic Vasospasms as a Life-Threatening Complication After Transsphenoidal Surgery

Vasospasm after transsphenoidal adenoma removal: risk factors and new treatment perspectives for this rare event.

“…Calcium-antagonist nimodipine is a well acknowledged therapy preventing vasospasm after aSAH and it was used in most part of cases of vasospasm after pituitary adenoma removal. However, even using it as a primary prevention some patients developed vasospasm 35 . Moreover, nimodipine, as a vasodilator, leads to hypotension, which should be carefully monitored in these patients 10 .…”

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

“…Rates of post-TSS vasospasm are unknown, but existing evidence suggests that the phenomenon is extremely rare. In the most compelling study on this topic, Osterhage et al retrospectively examined just under 2,000 consecutive microscopic TSS cases treated at their center over an eight-year period [9]. They identified symptomatic vasospasm as a postoperative complication in only four (0.2%) patients, two with a Rathke cleft cyst, one with a suprasellar craniopharyngioma, and one with a giant nonfunctioning pituitary adenoma.…”

“…The results of this study and others suggest a prominent role of subarachnoid blood in triggering a vasospastic response. In its own right, significant SAH is a rare complication of TSS that occurs in just 1% to 2% of cases [9,26]. There are limited data by which to ascertain how often SAH leads to the even rarer phenomenon of symptomatic vasospasm.…”

“…SAH has been observed in the majority of post-TSS vasospasm cases (84.6%) and is presumed to have a pathophysiological role, although vasospasm in the absence of SAH has been described [5][6][7][8]. Vasospasm is thought to be an infrequent contributor to the overall spectrum of ischemic complications after TSS, which includes direct injury to the internal carotid artery (ICA) and compression secondary to apoplexy [9]. However, the treatment of this idiosyncratic condition lacks evidence-based guidelines, and even with intensive care, the mortality rate associated with post-TSS vasospasm is approximately 30% [4,5,10].…”

“…Compared to the typical complications of pituitary tumor resection (e.g., diabetes insipidus [DI], pituitary insufficiency, cerebrospinal fluid [CSF] leak, meningitis, vision deficits), reports of symptomatic vasospasm after TSS are sparse [1,[4][5][6]9,[11][12][13][14][15][16][17][18][19]. As a consequence, very little is understood about the prevalence, etiology, and management of this condition.…”