Unusual cause of cerebral vasospasm after pituitary surgery

Abstract

Cerebral vasospasm (CVS) was described in patients after trans-sphenoidal pituitary surgery due to intra-operative trauma of arteries or blood clots around the arteries of Willis' circle. We consider that in the two presented cases the main cause of CVS in early postoperative period was meningitis. Two patients with pituitary adenomas were operated with trans-sphenoidal approach. CVS developed in early postoperative period. Meningitis was revealed in both cases. CVS regressed only after successful treatment of meningitis. In the first case empiric antibiotic therapy was ineffective and CVS remained until Klebsiella pneumonia was detected in CSF and specific therapy was performed. In the second case empiric therapy was effective and CVS vasospasm regressed in 12 days. These cases show that meningitis can be a leading cause of CVS in early postoperative period in trans-sphenoidal pituitary surgery. Adequate treatment of meningitis shortens duration of CVS in these patients.

Cerebral vasospasm following tumor resection

“…Tumors associated with postoperative vasospasm are often located in the sella region and have suprasellar extension 2 3 5 10–12 15 16 18 21–24 27 28 31 35 37 38. The distinctive anatomical relationships of sellar tumors to the major arteries of the circle of Willis make tumors in this area susceptible to be associated with postoperative vasospasm, especially in the setting of significant intraoperative bleeding and in the presence of vessel encasement or displacement by the tumor.…”

Cerebral Vasospasm Manifesting as a Transient Lesion of the Splenium of the Corpus Callosum Secondary to Pituitary Apoplexy

“…Another case of pituitary apoplexy resulted in bilateral carotid vasospasm and right parietal infarct, in the absence of surgical manipulation [6]. Cerebral vasospasm has also been reported as a consequence of meningitis after transsphenoidal pituitary surgery, although in this series, the presence of subsequent ischemic changes on neuroimaging was not assessed [7].…”

Cerebral Vasospasm after Open Fenestration of an Arachnoid Cyst in a 4-Year-Old Boy: Case Report and Review of the Literature

“…Adult CVS has been reported following open and endoscopic tumor resection [6-11, 13, 16, 20-24] and after rupture or resection of colloid and dermoid cysts [25, 26]. The suspected vasospasm triggers discussed in these cases include chemical meningitis [9, 11, 24, 27], intraoperative bleeding, subarachnoid blood, intracranial hypotension, vasoactive tumor antigens, intraoperative vessel manipulation, and Gelfoam [19].…”

“…The suspected vasospasm triggers discussed in these cases include chemical meningitis [9, 11, 24, 27], intraoperative bleeding, subarachnoid blood, intracranial hypotension, vasoactive tumor antigens, intraoperative vessel manipulation, and Gelfoam [19]. …”

“…It occurs most commonly after aneurysmal subarachnoid hemorrhage (aSAH) [1-3], and can also occur after traumatic brain injury (TBI) [4, 5]. Instances have been reported following tumor resection [6-11] and dermoid cyst rupture [6]. …”