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Background <p>Pituitary adenomas are common, and transsphenoidal surgery remains the standard treatment for symptomatic cases. While most postoperative complications are well described, symptomatic arterial vasospasm after pituitary surgery is exceptionally rare but potentially life-threatening, and no consensus exists regarding its management.</p> Methods <p>A systematic review was conducted following PRISMA 2020 guidelines across PubMed, Embase, Cochrane Library, Springer Nature, Academic Search Premier, JAMA Network, MEDLINE Complete, and ScienceDirect, without date restrictions. Eligible studies included case reports and reviews describing postoperative arterial vasospasm after pituitary adenoma surgery. Extracted data included demographics, tumor characteristics, surgical approach, presentation, diagnosis, treatment, and outcomes.</p> Results <p>Of 180 records screened, 28 met inclusion criteria, representing 40 patients, supplemented by one case from our series. In total, 41 patients were analyzed. Most tumors were macroadenomas (mean size 39&#xa0;mm), with 80% treated via a transsphenoidal approach. Intraoperative cerebrospinal fluid leakage occurred in 84%, and postoperative sellar hematoma or subarachnoid hemorrhage in 94%. Vasospasm typically developed around day 7 (mean 7.3 days), most often presenting with motor deficits or decreased consciousness, and consistently involved the anterior circulation, frequently affecting multiple vessels. Management strategies included triple-H therapy (68%), nimodipine (46%), and angioplasty (44%). Outcomes were poor, with 22.5% mortality, 32.5% residual deficits, and only 45% discharged without sequelae.</p> Conclusion <p>Symptomatic arterial vasospasm following pituitary surgery is rare but life-threatening. Intraoperative CSF leakage, sellar hematoma, or postoperative subarachnoid hemorrhage appear to increase risk. Vigilant monitoring and early, aggressive management following principles of aneurysmal subarachnoid hemorrhage are essential to optimize outcomes.</p> Clinical relevance statement <p>Symptomatic arterial vasospasm after pituitary surgery, though rare, carries a high risk of mortality and long-term disability, making early recognition and aggressive management in high-risk patients essential to improving outcomes.</p>

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Severe symptomatic arterial vasospasm following pituitary surgery: a rare case and systematic review of the literature

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Vincent Doat-Sarfati,
  • E. Lefevre,
  • PM. Chiaroni,
  • E. Shotar,
  • L. Abdennour,
  • V. Degos,
  • A. Jacquens

摘要

Background

Pituitary adenomas are common, and transsphenoidal surgery remains the standard treatment for symptomatic cases. While most postoperative complications are well described, symptomatic arterial vasospasm after pituitary surgery is exceptionally rare but potentially life-threatening, and no consensus exists regarding its management.

Methods

A systematic review was conducted following PRISMA 2020 guidelines across PubMed, Embase, Cochrane Library, Springer Nature, Academic Search Premier, JAMA Network, MEDLINE Complete, and ScienceDirect, without date restrictions. Eligible studies included case reports and reviews describing postoperative arterial vasospasm after pituitary adenoma surgery. Extracted data included demographics, tumor characteristics, surgical approach, presentation, diagnosis, treatment, and outcomes.

Results

Of 180 records screened, 28 met inclusion criteria, representing 40 patients, supplemented by one case from our series. In total, 41 patients were analyzed. Most tumors were macroadenomas (mean size 39 mm), with 80% treated via a transsphenoidal approach. Intraoperative cerebrospinal fluid leakage occurred in 84%, and postoperative sellar hematoma or subarachnoid hemorrhage in 94%. Vasospasm typically developed around day 7 (mean 7.3 days), most often presenting with motor deficits or decreased consciousness, and consistently involved the anterior circulation, frequently affecting multiple vessels. Management strategies included triple-H therapy (68%), nimodipine (46%), and angioplasty (44%). Outcomes were poor, with 22.5% mortality, 32.5% residual deficits, and only 45% discharged without sequelae.

Conclusion

Symptomatic arterial vasospasm following pituitary surgery is rare but life-threatening. Intraoperative CSF leakage, sellar hematoma, or postoperative subarachnoid hemorrhage appear to increase risk. Vigilant monitoring and early, aggressive management following principles of aneurysmal subarachnoid hemorrhage are essential to optimize outcomes.

Clinical relevance statement

Symptomatic arterial vasospasm after pituitary surgery, though rare, carries a high risk of mortality and long-term disability, making early recognition and aggressive management in high-risk patients essential to improving outcomes.