[Cerebrovascular accident with haemorrhagic transformation in a patient on antiplatelet treatment subjected to surgery of a hypophyseal macroadenoma].
The case is presented of a 51 year-old woman, proposed for endoscopic endonasal transsphenoidal resection of a hypophyseal macroadenoma diagnosed in the context of a stroke suffered 10 weeks before the date of the surgery. During this time, she had been treated with antiplatelet drugs, which were withdrawn 5 days before the surgery. The surgical procedure was performed without any incidents. On the second day after the surgery, the patient had an ischaemic infarction of the left cerebellar hemisphere, with signs of hydrocephaly and a posterior haemorrhagic transformation, with brain death 5 days after the operation. There are no definitive guidelines on the use of antiplatelet drugs in the perioperative period of neurosurgery. Also, there is no agreement as regards the waiting time between a cerebrovascular event and surgery, it appears that between 4 and 12 weeks would be the most advisable. The importance of an individual assessment of each patient before surgery is emphasised, as well as a review of the antiplatelet management of the patient with a risk of thrombosis in the context of neurosurgery, and their possible postoperative complications.
Universidad de Barcelona, Barcelona, España. mvendre1@clinic.ub.es
M
M
Vendrell
R
R
Valero
J
J
Mercadal
J
J
Enseñat
N
N
Fábregas
D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001039:Aphasia, Broca / Q000000981:diagnostic imaging / Q000209:etiology; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002531:Cerebellum / Q000098:blood supply; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D003399:Craniotomy; D018450:Disease Progression; D004322:Drainage; D004724:Endoscopy; D017809:Fatal Outcome; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006406:Hematoma / Q000139:chemically induced / Q000209:etiology / Q000601:surgery; D006801:Humans; D007016:Hypophysectomy; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D014715:Vertebrobasilar Insufficiency / Q000209:etiology
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin