title: Postoperative Cerebral Vasospasm Following Transsphenoidal Pituitary Adenoma Surgery.
abstract: OBJECTIVE
  Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease.
  
  
  METHODS
  A retrospective case report and literature review of presentation, treatment, and outcome of cerebral vasospasm following transsphenoidal surgery.
  
  
  RESULTS
  We present 1 case and review 12 known cases in the literature on vasospasm following transsphenoidal surgery. Mean age was 48 (±13.8) years. There were 46.2% male patients. Factors associated with vasospasm, such as cerebral spinal fluid leaks following surgery, were seen in 38.5% of cases, and postoperative subarachnoid hemorrhage (SAH) was seen in 84.6% of cases. Hemiparesis was the presenting symptom of delayed cerebral ischemia in 61.5% of cases. For management, maintaining at least a euvolemic volume status was used in 76.9%, induced hypertension was used in 61.5%, and nimodipine was administered in 46.2% of cases. Patients returned to their neurologic baseline in 61.5% of cases, had new permanent deficits in 7.7% of cases, and died in 30.8% of cases.
  
  
  CONCLUSIONS
  Cerebral vasospasm following transsphenoidal surgery is a dangerous disease that can lead to a high likelihood of mortality if not identified and treated. Early postoperative events, such as peritumoral subarachnoid hemorrhage and hemiparesis, may be factors associated with post-transsphenoidal surgery vasospasm. Effective treatment options used in patients that regained complete neurologic recovery were by inducing hypertension, maintaining euvolemia, and administering nimodipine.
authors.affiliation: Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Chikezie I
authors.initials: CI
authors.lastname: Eseonu
authors.affiliation: Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: ReFaey
authors.affiliation: Division of Neuroscience Critical Care, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Romergryko G
authors.initials: RG
authors.lastname: Geocadin
authors.affiliation: Department of Neurological Surgery and Oncology, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: aquinon2@jhmi.edu.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D019723:Endoscopes / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009666:Nose / Q000601:surgery; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D013100:Sphenoid Bone / Q000601:surgery; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Cerebral vasospasm; Macroadenoma; Pituitary; Transsphenoidal; Treatment