Rare fatal vascular complication of transsphenoidal surgery.
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.
Kurschel
S
S
Department of Neurosurgery, Medical University, Graz, Austria. senta.kurschel@meduni-graz.at
Leber
K A
KA
Scarpatetti
M
M
Roll
P
P
D000236:Adenoma / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017809:Fatal Outcome; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007049:Iatrogenic Disease / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010899:Pituitary Apoplexy / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D010902:Pituitary Gland / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed