Fatal postoperative 'pituitary apoplexy': its cause and management

Two cases of giant pituitary tumours are reported. The patients underwent transcranial operation, one by the pterional and one by the subfrontal route. Only partial resection of the tumour was possible in each instance for various reasons. Acute worsening of the clinical condition in the immediate postoperative phase led to reoperation in both patients. In one case the reoperation was carried out within 45 min of the closure of the wound and in the other after 12 h. Massive swelling of the tumour with evidence of haemorrhagic infarction was a surprise finding. After a turbulent postoperative phase, both patients died. We postulate that these patients developed pituitary apoplexy of the residual tumours.