title: 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.
authors.affiliation: Neurocritical Care Department, Russian Academy of Medical Sciences, Moscow, Russia. Stan.Popugaev@yahoo.com
authors.forename: K A
authors.initials: KA
authors.lastname: Popugaev
authors.forename: I A
authors.initials: IA
authors.lastname: Savin
authors.forename: A U
authors.initials: AU
authors.lastname: Lubnin
authors.forename: A S
authors.initials: AS
authors.lastname: Goriachev
authors.forename: B A
authors.initials: BA
authors.lastname: Kadashev
authors.forename: P L
authors.initials: PL
authors.lastname: Kalinin
authors.forename: I N
authors.initials: IN
authors.lastname: Pronin
authors.forename: A V
authors.initials: AV
authors.lastname: Oshorov
authors.forename: M A
authors.initials: MA
authors.lastname: Kutin
mesh_terms: D000792:Angiography; D002533:Cerebral Angiography; D002555:Cerebrospinal Fluid / Q000166:cytology; D005260:Female; D023261:Glasgow Outcome Scale; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D013353:Subdural Effusion / Q000473:pathology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy; D017287:Ventriculoperitoneal Shunt
chemical_list: D005947:Glucose