Rare Fatal Vascular Complication of Transsphenoidal Surgery

Abstract

Background: Transsphenoidal surgery is considered to be a safe, relatively low risk procedure for the resection of pituitary lesions. Bilateral internal carotid artery thrombosis after transsphenoidal surgery is extremely uncommon with only few cases as per the author’s review of the literature. We describe a case of bilateral internal carotid artery thrombosis after transsphenoidal surgery for pituitary macroadenoma and review the literature on this rare entity.

Case presentation: A 39-year-old man, who underwent transsphenoidal surgery for a pituitary macroadenoma. The presence of soft and suction able nature of the tumor permitted to total resection. Progressive loss of consciousness 18 hours after surgery occurred, an emergency CT scan showed no evidence of hemorrhage but stroke in domain of both internal carotid artery. Twenty hours later, MRA revealed arrest of arterial flow and thrombosis of intracvernosis portion of both internal carotid arteries resulting   this extensive stroke. On the fifth postoperative day, the patient died as a result of this extensive stroke

Conclusion: IT should be in our mind that this rare complication may occur in   transsphenoidal pituitary surgery and is not avoidable, early diagnosis is important to try to prevent this serious complications.

 Keywords: Pituitary Adenoma, Cerebral Infarction, Bilateral Carotid thrombosis