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Symptomatic Vasospasms as a Life-Threatening Complication After Transsphenoidal Surgery
Katharina Osterhage1, Patrick Czorlich1, Till R Burkhardt1
1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Objective:
To identify symptomatic vasospasms as a rare complication after transsphenoidal surgery, with emphasis on management and outcomes.
Methods:
In this retrospective study, the medical records of 1997 patients who underwent microscopic transsphenoidal surgery at our hospital between 2008 and 2016 were analyzed regarding postoperative vasospasm events, clinical management, and neurologic outcomes.
Results:
Four patients (0.2%) were identified who developed neurologic deficits in the postoperative phase caused by proven vasospasms due to subarachnoid hemorrhage (SAH). All 4 patients were treated according to current state-of-the-art recommendations for SAH-triggered vasospasms and, as ultima ratio, intra-arterial spasmolysis. Nonetheless, all patients developed multilocular ischemic infarctions. Three patients recovered with no or only slight neurologic deficits (2 with a Glasgow Outcome Score [GOS] of 5; 1 with a GOS of 4), and 1 patient died, at 24 days after surgery.
Conclusions:
Although a rare complication, vasospasms after transsphenoidal surgery can lead to severe and multilocular ischemic infarctions with a wide variety of neurologic impairments. This rare complication should be considered in patients with unexpected postoperative neurologic deficits. Computed tomography (CT)/magnetic resonance imaging and (contrast-enhanced) CT/magnetic resonance angiography are appropriate diagnostic tools. Treatment of vasospasms, including the option of intra-arterial spasmolysis, should not be delayed.
Insights
Symptomatic vasospasms are a rare but serious complication following transsphenoidal surgery. Prompt diagnosis and treatment, including intra-arterial spasmolysis, are crucial for managing these events and improving patient outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Transsphenoidal surgery is a common procedure for pituitary adenomas and other skull base lesions.
- Postoperative complications can significantly impact patient outcomes.
Observation:
- This study identified symptomatic vasospasms in 0.2% of 1997 patients undergoing transsphenoidal surgery.
- Vasospasms were diagnosed in the postoperative phase, often secondary to subarachnoid hemorrhage.
Findings:
- All identified patients developed multilocular ischemic infarctions despite state-of-the-art treatment, including intra-arterial spasmolysis.
- Neurologic outcomes varied, with three patients experiencing mild deficits and one mortality.
Implications:
- Vasospasms should be considered in patients with unexpected postoperative neurologic deficits after transsphenoidal surgery.
- Advanced imaging like CT/MR angiography is essential for diagnosis.
- Timely intervention, including intra-arterial spasmolysis, is critical.
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