title: Ischemic complications after pituitary surgery: a report of two cases.
abstract: BACKGROUND
  Cerebral ischemic complications after pituitary surgery are not frequently reported. These vascular complications may be related to (1) direct trauma to the vessel wall, (2) compression of the internal carotid artery (ICA) due to pituitary apoplexy, (3) vasospasm secondary to subarachnoid hemorrhage or vasoactive tumor extract, or (4) hypothalamic injury.
  
  
  METHODS
  We describe two cases where major vessel infarcts occurred after removal of pituitary tumor. One case has repeated episodes of thrombembolism probably due to a internal carotid artery (ICA) dissection triggered by minor intraoperative ICA injury during transsphenoidal excision. The other cases had a late-onset cerebral ischemia due vasospasm of middle cerebral artery after transcranial excision of a large pituitary tumor.
  
  
  RESULTS
  Both patients had a long hospital stay and were managed successfully with anticoagulant and antiplatelet drugs, aggressive supportive care in the intensive care unit, and rehabilitation.
  
  
  CONCLUSIONS
  These cases highlight two different mechanisms of infarcts after pituitary surgery. The first case highlights the importance of ICA evaluation before surgery in elderly patients with risk factors, such as chronic smoking, hypertension, and atherosclerotic disease. Even minimal manipulation of the ICA can generate a cascade of thrombembolic events in such patients. The second case highlights the importance of observing the patient of a highly vascular giant pituitary adenoma in the hospital for a longer than usual time. Delayed vasospasm can occur like in aneurysmal subarachnoid hemorrhage and have a good outcome if detected early and managed judiciously.
authors.affiliation: Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, New Delhi, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, G. B. Pant Hospital, University of Delhi, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Biochemistry, G. B. Pant Hospital, University of Delhi, New Delhi, India.
authors.forename: Richa
authors.initials: R
authors.lastname: Vaishya
authors.affiliation: Department of Anaesthesiology, G. B. Pant Hospital, University of Delhi, New Delhi, India.
authors.forename: Monica
authors.initials: M
authors.lastname: Tandon
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000628:therapy; D002544:Cerebral Infarction / Q000209:etiology; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000601:surgery; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000473:pathology; D007431:Intraoperative Complications / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy*; D015175:Prolactinoma / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome