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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.
World Neurosurgery
|October 19, 2017
Summary
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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