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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Vasospasm as a life threatening complication after pituitary surgery

Meeting Abstract

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  • Katharina Osterhage - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie, Hamburg, Deutschland
  • Till Burkhardt - Neurochirurgie/Universtätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Roman Rotermund - Hamburg, Deutschland
  • Ulrich Grzyska - Universitätsklinikum Hamburg-Eppendorf, Neuroradiologische Diagnostik und Intervention, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Jörg Flitsch - University Hospital Hamburg-Eppendorf, Neurosurgery, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.19.03

doi: 10.3205/17dgnc494, urn:nbn:de:0183-17dgnc4947

Published: June 9, 2017

© 2017 Osterhage et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To identify clinically relevant vasospasms as a rare complication after pituitary surgery with emphasis on management and outcome.

Methods: In a retrospective design, 1900 patient charts undergoing transsphenoidal pituitary surgery from January 2008 through Octobre 2016 were retrospectively analyzed regarding postoperative, vasospasmic events, its’ management and neurological outcome.

Results: Four patients (0,2%) who developed neurological deficits in the postoperative phase caused by vasospasms – as identified by neuroradiological means - were identified. Patients were treated according to current state-of-the-art recommendations for SAH triggered vasospasms, including intra-arterial spasmolysis. Nevertheless multilocular ischemic infarctions developed in all 4 patients. Three patients recovered with no or only slight neurological deficit. (Glasgow Outcome Score 5 twice, 4 once), one patient deceased due to large bihemispherial infarction.

Conclusion: Although a rare complication, vasospasms after pituitary surgery can lead to severe ischemic infarctions and thus neurological impairment. In case of unexpected postoperative neurological deficit following transsphenoidal pituitary surgery, this rare complication should be considered and adequate and immediate imaging should be performed. MR imaging and (contrast-enhanced) MR angiography are an appropriate diagnostic tool, treatment of vasospasms including local intra-arterial spasmolysis, if necessary, should not be delayed.