Clinical vasospasm after an extended endoscopic assisted approach for recurrent pituitary adenoma. Illustrative case and systematic review of the literature.

World Neurosurg 2019 Apr 16. Epub 2019 Apr 16.

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università; degli Studi di Napoli "Federico II", Naples, Italy.

Introduction: Cerebral vasospasm causing delayed cerebral ischemia after transsphenoidal surgery is a rare but life-threatening complication. Reports in the literature regarding extended endonasal endoscopic assisted (EEEA) approaches are scarce. Considering the progressive use of this technique during the last years, a better understanding of potential adverse effects after this procedure is needed. Aim of this report was to systematically analyze current literature and discuss management and causes for cerebral vasospasm after extended endonasal endoscopic assisted surgery.

Methods: We performed a systematic search of the literature according to the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) statement and aimed to discuss relevant risk factors for cerebral vasospasm after extended transsphenoidal surgery.

Results: Thirty-four cases of delayed cerebral vasospasm after transsphenoidal surgery were identified. Among these, four were operated with an EEEA approach. We provide an extensive literature review and discuss causes and management of this delayed complication. We further present the case of a young female who underwent EEEA resection for a large suprasellar recurrent pituitary adenoma. Surgery and initial postoperative course were uneventful. On the 8 postoperative day, patient developed aphasia and brachiofacial paresis. Digital subtraction angiography (DSA) demonstrated cerebral vasospasm and repeated intra-arterial nimodipine infusion was administrated. The patient recovered completely and was discharged without neurological deficits.

Conclusion: The threshold for DSA after unexplained neurological deterioration following transsphenoidal surgery should be low and cerebral vasospasm should be treated early and aggressively. Surgeons performing EEEA approaches need to consider the possibility of this delayed complication.

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http://dx.doi.org/10.1016/j.wneu.2019.04.046DOI Listing
April 2019
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