A case of cerebral arterial vasospasm following removal of a large chromophobe putuitary adenoma by the subfrontal approach was presented. The patient, a 48-year-old male, suffered from progressively disturbed vision. He also complained of headache, easy fatigability, and decreased libido. The axillary and pubic hair was decreased. He suffered complete loss of vision in the right eye and a temporal field cut in the left eye. Both optic disks were pale due to optic nerve atrophy. Plain skull X-rays showed an enlarged sella turcica without any calcification.
Computed tomography showed homogenous contrast enhancement of a tumor in the sellar region which extended to the suprasellar region. Angiographic studies demonstrated lateral displacement of the internal carotid artery, elevation of the anterior cerebral artery, and a large homogenous vascular stain from the late arterial phase to the late venous phase without vasospasm.
A right frontotemporal craniotomy was performed. A gross total removal of the tumor was accomplished. No vascular spasm was evident at the time of closure. The pathological diagnosis was a chromophobe pituitary adenoma.
The postoperative course was uneventful except for diabetes insipidus until the seventh postoperative day, when the patient developed a left hemiplegia and became stuporous. Emergent angiography showed severe vasospasms around the right internal carotid artery bifurcation extending to the C₁, A₁, and M₁ portions. Precontrast computed tomography revealed a slightly high-dense area in the basal cistern.
The vasospasm disappeared almost completely in right carotid angiography on the twenty-third postoperative day. On the thirtieth postoperative day, he remained demented, in a state of urinary incontinence, and still had the left hemiplegia. On the forty-fifth postoperative day, computed tomography showed marked ventricular dilatation with periventricular lucency. A ventriculo-peritoneal shunting operation was performed to treat the communicating hydrocephalus. His clinical symptoms gradually improved. Seven months after surgery, he was able to walk by himself with a cane.
Seven other cases were included in the discussion. The mechanism underlying this unusual complication was thought to be postoperative bleeding in the basal subarachnoid space, although a hypothesis that chemical vasoactive agents are liberated from the tumor bed into the subarachnoid space can not be ignored.