Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Neurosurgery. 2012 Sep;71(1 Suppl Operative):173-80; discussion 180-1. doi: 10.1227/NEU.0b013e31824aae21.
Delayed ischemic events due to vasospasm are a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). Severe vasospasm in other neurosurgical settings is not as well recognized. Delay in diagnosis and treatment of vasospasm in such settings may be associated with significant neurological morbidity.
To present three cases of symptomatic delayed cerebral vasospasm after transsphenoidal resection of pituitary macroadenomas.
Transsphenoidal resection in all cases was complicated by peritumoral hemorrhage with extension into the subarachnoid space. Two of the 3 patients required re-operation to evacuate the hematoma in the tumor bed because of progressive worsening neurological deficits.
All 3 patients developed vasospasm of the intracranial vessels, starting as early as postoperative day 5 and appearing as late as postoperative day 10. Comparisons to the non-vascular pre-operative magnetic resonance imaging studies confirmed the "de-novo" nature of the vasospasm based on the caliber of the flow voids.
Transsphenoidal surgery complicated by peritumoral hemorrhage is associated with a significant risk of neurological morbidity because of delayed cerebral vasospasm. Early recognition and management according to guidelines used for postaneurysmal SAH may help to improve outcomes in these patients.
由于血管痉挛引起的迟发性缺血事件是蛛网膜下腔出血（SAH）的一种已知并发症。在其他神经外科情况下，严重的血管痉挛并不那么容易被识别。在这些情况下，血管痉挛的诊断和治疗延迟可能与显著的神经功能障碍有关。
介绍 3 例经蝶窦切除垂体大腺瘤后出现症状性迟发性脑血管痉挛的病例。
所有病例的经蝶窦切除术均因肿瘤周围出血并延伸至蛛网膜下腔而复杂化。由于神经功能缺损逐渐加重，其中 2 例患者需要再次手术清除肿瘤床内的血肿。
所有 3 例患者均出现颅内血管痉挛，最早发生在术后第 5 天，最晚发生在术后第 10 天。与术前非血管磁共振成像研究的比较证实了血管痉挛的“新发”性质，这是基于血流空化的口径。
经蝶窦手术并发肿瘤周围出血与迟发性脑血管痉挛引起的显著神经功能障碍风险相关。根据蛛网膜下腔出血后使用的指南进行早期识别和管理可能有助于改善这些患者的预后。
