Symptomatic Vasospasms as a Life-Threatening Complication After Transsphenoidal Surgery

TY - JOUR

T1 - Symptomatic Vasospasms as a Life-Threatening Complication After Transsphenoidal Surgery

AU - Osterhage, Katharina

AU - Czorlich, Patrick

AU - Burkhardt, Till R

AU - Rotermund, Roman

AU - Grzyska, Ulrich

AU - Flitsch, Jörg

N1 - Copyright © 2017. Published by Elsevier Inc.

PY - 2018/2

Y1 - 2018/2

N2 - OBJECTIVE: To identify symptomatic vasospasms as a rare complication after transsphenoidal surgery, with emphasis on management and outcomes.METHODS: In this retrospective study, the medical records of 1997 patients who underwent microscopic transsphenoidal surgery at our hospital between 2008 and 2016 were analyzed regarding postoperative vasospasm events, clinical management, and neurologic outcomes.RESULTS: Four patients (0.2%) were identified who developed neurologic deficits in the postoperative phase caused by proven vasospasms due to subarachnoid hemorrhage (SAH). All 4 patients were treated according to current state-of-the-art recommendations for SAH-triggered vasospasms and, as ultima ratio, intra-arterial spasmolysis. Nonetheless, all patients developed multilocular ischemic infarctions. Three patients recovered with no or only slight neurologic deficits (2 with a Glasgow Outcome Score [GOS] of 5; 1 with a GOS of 4), and 1 patient died, at 24 days after surgery.CONCLUSIONS: Although a rare complication, vasospasms after transsphenoidal surgery can lead to severe and multilocular ischemic infarctions with a wide variety of neurologic impairments. This rare complication should be considered in patients with unexpected postoperative neurologic deficits. Computed tomography (CT)/magnetic resonance imaging and (contrast-enhanced) CT/magnetic resonance angiography are appropriate diagnostic tools. Treatment of vasospasms, including the option of intra-arterial spasmolysis, should not be delayed.

AB - OBJECTIVE: To identify symptomatic vasospasms as a rare complication after transsphenoidal surgery, with emphasis on management and outcomes.METHODS: In this retrospective study, the medical records of 1997 patients who underwent microscopic transsphenoidal surgery at our hospital between 2008 and 2016 were analyzed regarding postoperative vasospasm events, clinical management, and neurologic outcomes.RESULTS: Four patients (0.2%) were identified who developed neurologic deficits in the postoperative phase caused by proven vasospasms due to subarachnoid hemorrhage (SAH). All 4 patients were treated according to current state-of-the-art recommendations for SAH-triggered vasospasms and, as ultima ratio, intra-arterial spasmolysis. Nonetheless, all patients developed multilocular ischemic infarctions. Three patients recovered with no or only slight neurologic deficits (2 with a Glasgow Outcome Score [GOS] of 5; 1 with a GOS of 4), and 1 patient died, at 24 days after surgery.CONCLUSIONS: Although a rare complication, vasospasms after transsphenoidal surgery can lead to severe and multilocular ischemic infarctions with a wide variety of neurologic impairments. This rare complication should be considered in patients with unexpected postoperative neurologic deficits. Computed tomography (CT)/magnetic resonance imaging and (contrast-enhanced) CT/magnetic resonance angiography are appropriate diagnostic tools. Treatment of vasospasms, including the option of intra-arterial spasmolysis, should not be delayed.

KW - Journal Article

U2 - 10.1016/j.wneu.2017.10.027

DO - 10.1016/j.wneu.2017.10.027

M3 - SCORING: Journal article

C2 - 29045853

VL - 110

SP - 180

EP - 188

JO - WORLD NEUROSURG

JF - WORLD NEUROSURG

SN - 1878-8750

ER -