POSTOPERATIVE VASOSPASM IN PITUITARY ADENOMA WITH PITUITARY APOPLEXY

Abstract

A patient who developed complications relating to intracranial arterial vasospasm following transcranial removal of a pituitary adenoma with pituitary apoplexy is reported. A 23-year-old female was admitted because of headache. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a pituitary adenoma with suprasellar extension and pituitary apoplexy and sinusitis in the right maxillary and ethmoid sinuses. A transcranial approach was selected because of active sinusitis. A large, pink intra- and suprasellar neoplasm and intratumoral clot were removed smoothly. Postoperatively, the patient remained stuporous and showed right hemiplegia. Angiography demonstrated stenosis of the left internal carotid artery and severe spasm of perforating arteries from the left middle cerebral artery. Large pituitary adenoma with pituitary apoplexy requires careful perioperative management, with particular attention paid to the surgical approach and procedures.