JOANNA SAWICKA
College of Medical Sciences of University of Rzeszów, Poland
Title: Ischemic stroke complicating transsphenoidal pituitary macroadenoma resection.
Biography
Biography: JOANNA SAWICKA
Abstract
Introduction:
Macroadenomas are common beningn hypophyseal tumours, that may cause disruption of visual field [1] or other symptoms by mass effect [2]. Following the diagnosis a trans-sphenoid tumor removal is the treatment of choice in patients with visual field impairment [3]. We would like to present a rare case of a patient with ischemic stroke being an macroadenoma resection complication.
Case report:
A 47-year old female was admitted to the Clinic of Neurosurgery for removal of a nonfunctioning macroadenoma of pituitary gland causing progressive decrement of visual field. A trans-sphenoidal resection was performed with the tumor incomplete resection. Sudden dysarthria and right side hemiplegia have been observed in 24h post-operative period. The MRI revealed an ischemic area of left subcortical region and intrapituitary hemorrhage with substantial regional edema. Several days after surgery prominent mixed aphasia appeard and enlargement of ischemic area to entire left MCA supply territory. Compression of distal ICA or proximal MCA by sudden volumetric expansion of the macroadenoma as a result of bleeding inside the tumor was considered the most probable mechanism of ischemia.
Conclusions:
Transsphenoidal surgery is a procedure of choice for removal of the pituitary macroadenoma. It is considered safe, but occasionally serious complications of surgery can occur, with pituitary apoplexy being one of them. The postoperative hemorrhage into residual adenoma may cause compression of adjacent structures including optic chiasm, cranial nerves and distal portion of ICA. The latter complication is extremally rare and was reported in only few case reports.