Alsayadi Somayah, Ochoa-Sanchez Rafael, Moldovan Ioana D, Alkherayf Fahad
1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
2Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; and.
J Neurosurg Case Lessons. 2023 Feb 13;5(7). doi: 10.3171/CASE22349.
Cerebral vasospasm is a rare but devastating complication following pituitary apoplexy. Cerebral vasospasm is often associated with subarachnoid hemorrhage (SAH), and early detection is crucial for proper management.
The authors present a case of cerebral vasospasm after endoscopic endonasal transsphenoid surgery (EETS) in a patient with pituitary apoplexy secondary to pituitary adenoma. They also present a literature review of all similar cases published to date. The patient is a 62-year-old male who presented with headache, nausea, vomiting, weakness, and fatigue. He was diagnosed with pituitary adenoma with hemorrhage, for which he underwent EETS. Pre- and postoperative scans showed SAH. On postoperative day 11, he presented with confusion, aphasia, arm weakness, and unsteady gait. Magnetic resonance imaging and computed tomography scans were consistent with cerebral vasospasm. The patient underwent endovascular treatment of acute intracranial vasospasm and was responsive to intra-arterial milrinone and verapamil infusion of the bilateral internal carotid arteries. There were no further complications.
Cerebral vasospasm is a severe complication that can occur after pituitary apoplexy. It is essential to assess the risk factors linked to the cerebral vasospasm. In addition, a high index of suspicion will allow neurosurgeons to diagnose cerebral vasospasm after EETS early and take the necessary measures to manage it accordingly.
脑血管痉挛是垂体卒中后一种罕见但极具破坏性的并发症。脑血管痉挛常与蛛网膜下腔出血（SAH）相关，早期检测对于恰当处理至关重要。
作者报告了1例垂体腺瘤继发垂体卒中患者在内镜鼻内经蝶窦手术（EETS）后发生脑血管痉挛的病例。他们还对迄今已发表的所有类似病例进行了文献综述。该患者为一名62岁男性，出现头痛、恶心、呕吐、乏力和疲劳症状。他被诊断为垂体腺瘤伴出血，并接受了EETS。术前和术后扫描显示有SAH。术后第11天，他出现意识模糊、失语、手臂无力和步态不稳。磁共振成像和计算机断层扫描结果与脑血管痉挛相符。该患者接受了急性颅内血管痉挛的血管内治疗，对双侧颈内动脉动脉内输注米力农和维拉帕米有反应。未出现进一步并发症。
脑血管痉挛是垂体卒中后可能发生的一种严重并发症。评估与脑血管痉挛相关的危险因素至关重要。此外，高度的怀疑指数将使神经外科医生能够在EETS后早期诊断脑血管痉挛，并采取必要措施进行相应处理。
