Rare fatal vascular complication of transsphenoidal surgery

• Published in: Acta neurochirurgica Vol. 147; no. 3; pp. 321 - 5; discussion 325
• Main Authors: Kurschel, S, Leber, K A, Scarpatetti, M, Roll, P
• Format: Journal Article
• Language: English
• Published: Austria Springer Nature B.V 01.03.2005
• Subjects: Adenoma - blood supply; Adenoma - pathology; Adenoma - surgery; Carotid Artery Injuries - etiology; Carotid Artery Injuries - pathology; Carotid Artery Injuries - physiopathology; Carotid Artery, Internal - pathology; Carotid Artery, Internal - physiopathology; Cerebral Infarction - etiology; Cerebral Infarction - pathology; Cerebral Infarction - physiopathology; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - pathology; Cerebrovascular Disorders - physiopathology; Fatal Outcome; Humans; Hypotension - diagnosis; Hypotension - etiology; Hypotension - prevention & control; Iatrogenic Disease - prevention & control; Magnetic Resonance Imaging; Male; Middle Aged; Monitoring, Physiologic - standards; Neurosurgical Procedures - adverse effects; Pituitary Apoplexy - complications; Pituitary Apoplexy - pathology; Pituitary Apoplexy - physiopathology; Pituitary gland; Pituitary Gland - blood supply; Pituitary Gland - pathology; Pituitary Gland - surgery; Pituitary Neoplasms - blood supply; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Reoperation; Sella Turcica - diagnostic imaging; Sella Turcica - pathology; Sella Turcica - surgery; Sphenoid Bone - diagnostic imaging; Sphenoid Bone - pathology; Sphenoid Bone - surgery; Surgery; Tomography, X-Ray Computed
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-004-0442-x

We report the case of a 61-year-old man, who underwent transsphenoidal surgery for a pituitary macroadenoma. The presence of tough fibrous septa dividing the tumour permitted only a partial resection. Progressive loss of consciousness soon after surgery occurred, an emergency CT scan showed no evidence of haemorrhage. Twenty hours later, MRI revealed compression of both internal carotid arteries with arrest of arterial flow resulting in stroke by an enlarged haemorrhagic mass consistent with a pituitary apoplexy. On the second postoperative day, the patient died as a result of this extensive stroke. The mechanisms of this rare complication after transsphenoidal surgery are theorized and the sensitivity of imaging methods is discussed.