Savage E B, Gugino L, Starr P A, Black P M, Cohn L H, Aranki S F
Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Eur J Cardiothorac Surg. 1994;8(6):333-6. doi: 10.1016/s1010-7940(05)80095-8.
Pituitary apoplexy in a pre-existing pituitary tumor can result in serious and permanent neurologic deficits following cardiac surgical procedures. Several factors related to the altered physiology of cardiopulmonary bypass (CPB) contribute separately or in combination to the development of this syndrome. Over the last year we have encountered two such cases in whom emergency and prompt decompression of the adenoma resulted in an improvement of the initial clinical presentation but nevertheless persistence of residual and devastating ocular manifestations. In the literature six similar cases have been reported following cardiac surgical procedures, with similar outcomes. In this report we describe our experience and management of these two patients, and that published in the literature. We propose a possible role for a staged cardiac and neurosurgical procedure as a prophylactic measure in patients with known pituitary tumor. The role of cerebral monitoring is also discussed.
既往存在垂体瘤的患者发生垂体卒中可导致心脏外科手术后出现严重且永久性的神经功能缺损。与体外循环（CPB）生理改变相关的几个因素单独或共同作用导致了该综合征的发生。在过去一年里，我们遇到了两例这样的病例，对腺瘤进行紧急且及时的减压后，初始临床表现有所改善，但仍残留严重的眼部表现。文献报道了6例心脏外科手术后出现的类似病例，结果相似。在本报告中，我们描述了我们对这两名患者的经验和处理方法，以及文献中发表的相关内容。我们提出，对于已知患有垂体瘤的患者，分期进行心脏和神经外科手术作为一种预防措施可能具有一定作用。还讨论了脑监测的作用。
