Aihara Satoshi, Umegaki Takeshi, Soeda Takehiro, Iwamura Haruka, Takeda Junichi, Nonaka Masahiro, Kamibayashi Takahiko
Department of Anesthesiology, Kansai Medical University, Hirakata, Japan.
Department of Neurosurgery, Kansai Medical University, Hirakata, Japan.
Surg Neurol Int. 2024 Jun 14;15:201. doi: 10.25259/SNI_342_2024. eCollection 2024.
Cerebral vasospasm is a rare postoperative complication of transsphenoidal pituitary adenoma surgery with potentially severe consequences. These vasospasms generally have a delayed presentation at a mean of 8 postoperative days. We report an unusual case of hyperacute onset of cerebral vasospasm that occurred immediately after surgery.
A 38-year-old man underwent endoscopic transsphenoidal surgery for a nonfunctioning pituitary adenoma. The patient experienced mild subarachnoid hematoma during surgery. Three hours after surgery, he developed rightward conjugate eye deviation and complete paralysis of the left upper and lower extremities. Diagnostic imaging revealed cerebral vasospasm in both middle cerebral arteries, and symptoms improved after intra-arterial administration of fasudil hydrochloride.
There is a need for prompt diagnosis and therapeutic intervention when typical symptoms of cerebral vasospasm, such as paralysis, occur at any time during the postoperative course.
脑血管痉挛是经蝶窦垂体腺瘤手术罕见的术后并发症，可能产生严重后果。这些血管痉挛通常在术后平均8天延迟出现。我们报告了1例术后立即发生的超急性脑血管痉挛的罕见病例。
一名38岁男性因无功能性垂体腺瘤接受了内镜经蝶窦手术。患者在手术期间出现轻度蛛网膜下腔血肿。术后3小时，他出现右眼共轭偏斜及左上下肢完全瘫痪。诊断性影像学检查显示双侧大脑中动脉均有脑血管痉挛，动脉内注射盐酸法舒地尔后症状改善。
当术后过程中任何时间出现脑血管痉挛的典型症状（如瘫痪）时，需要及时诊断并进行治疗干预。
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