Neurocritical Care Department, Russian Academy of Medical Sciences, Moscow, Russia.
Neurol Sci. 2011 Aug;32(4):673-80. doi: 10.1007/s10072-011-0482-y. Epub 2011 Feb 3.
Cerebral vasospasm (CVS) was described in patients after trans-sphenoidal pituitary surgery due to intra-operative trauma of arteries or blood clots around the arteries of Willis' circle. We consider that in the two presented cases the main cause of CVS in early postoperative period was meningitis. Two patients with pituitary adenomas were operated with trans-sphenoidal approach. CVS developed in early postoperative period. Meningitis was revealed in both cases. CVS regressed only after successful treatment of meningitis. In the first case empiric antibiotic therapy was ineffective and CVS remained until Klebsiella pneumonia was detected in CSF and specific therapy was performed. In the second case empiric therapy was effective and CVS vasospasm regressed in 12 days. These cases show that meningitis can be a leading cause of CVS in early postoperative period in trans-sphenoidal pituitary surgery. Adequate treatment of meningitis shortens duration of CVS in these patients.
脑动脉痉挛（CVS）在经蝶窦垂体手术后的患者中被描述，这是由于Willis 环动脉或动脉周围的血液凝块术中创伤所致。我们认为，在这两个病例中，CVS 在术后早期的主要原因是脑膜炎。两名垂体腺瘤患者接受了经蝶窦入路手术。术后早期出现 CVS。在两种情况下均发现了脑膜炎。仅在成功治疗脑膜炎后，CVS 才消退。在第一个病例中，经验性抗生素治疗无效，并且直到 CSF 中检测到肺炎克雷伯菌并进行了特异性治疗后，CVS 才持续存在。在第二个病例中，经验性治疗有效，CVS 痉挛在 12 天内消退。这些病例表明，脑膜炎可能是经蝶窦垂体手术后早期 CVS 的主要原因。充分治疗脑膜炎可缩短这些患者 CVS 的持续时间。
