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  • Vasospasm Following Pituitary Adenoma Resection: Systematic Review of Literature and Report of 3 Cases

    Final Number:
    1219

    Authors:
    Alireza Mansouri MD; Aria Fallah MD; Michael Cusimano MD; Sunit Das MD PhD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Vasospasm is a known complication of aneurysmal subarachnoid hemorrhage and is a major cause of neurological morbidity and mortality. It is infrequently associated with pituitary adenoma surgery. We report three cases and present a systematic review of the literature with a view towards guiding neurosurgeons in the prevention and management of this complication.

    Methods: Systematic review of literature.

    Results: Including our experience, vasospasm complicating pituitary adenoma surgery has been documented in 29 patients (mean age of 45). All cases occurred in the setting of a postoperative hemorrhage: 21 had a subarachnoid hemorrhage and 10 had a postoperative hematoma requiring evacuation. Initial clinical appearance of delayed cerebral ischemia attributable to vasospasm occurred from postoperative days 2-13 (most commonly day 5). Digital subtraction angiography and medical management were the most common diagnostic and therapeutic strategies, respectively. Glasgow Outcome Scores were =3 in 59% of cases. Multivariate logistic regression identified later diagnosis of vasospasm and surgery for hematoma evacuation to be independently associated with better outcomes.

    Conclusions: Vasospasm should be considered in the differential diagnosis of patients demonstrating altered mental or neurological status following pituitary surgery, particularly if there has been postoperative hemorrhage of any degree. Prompt treatment should be instituted to optimize outcome.

    Patient Care: The grave outcome associated with a delayed diagnosis of vasospasm following pituitary adenoma resection emphasizes the importance of considering it on the differential and managing it promptly for optimal outcome.

    Learning Objectives: The goal of this session is to: 1) Emphasize the importance of considering vasospasm as part of the differential diagnosis for patients with an altered level of consciousness following pituitary adenoma resection and 2) Present strategies for the optimal approach to preventing and managing this complication.

    References:

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