经蝶窦切除复发性垂体大腺瘤后基底动脉血管痉挛:说明性病例。

Luke R Jackson, Joshua Miles Diamond, Prashant Chittiboina
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引用次数: 0

摘要

背景:脑血管痉挛是经蝶窦手术(TSS)中一种罕见但严重的并发症。虽然其病因尚不完全清楚,但早期发现对于适当治疗至关重要。观察:作者报告了一例35岁的女性肢端肥大症患者,她接受了TSS切除生长肥大大腺瘤。腺瘤及其假包膜被完全切除,未见脑脊液渗漏。术后影像学显示在针间池有明显的血制品。术后一周,患者以构音障碍、右侧共济失调和右眼外斜视就诊。CT血管造影发现颅底尖端血管痉挛,随后MRI显示中脑梗死。患者入院,接受积极的液体复苏,然后在生命体征稳定,行动和语言改善后出院。随访3个月,右眼不完全会聚消失。经验:作者报告一例罕见的经蝶窦切除垂体大腺瘤后发生脑血管痉挛的病例,并讨论了对中脑束的影响。https://thejns.org/doi/10.3171/CASE25453。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Basilar artery vasospasm following transsphenoidal resection of recurrent pituitary macroadenoma: illustrative case.

Background: Cerebral vasospasm is a rare yet serious complication of transsphenoidal surgery (TSS). While its etiology is incompletely understood, early detection is critical for proper management.

Observations: The authors report the case of a 35-year-old female with acromegaly who underwent TSS for resection of somatotroph macroadenoma. The adenoma was completely removed with its pseudocapsule, and no CSF leakage was encountered. Postoperative imaging was notable for blood products in the interpeduncular cistern. A week after surgery, she presented to the clinic with dysarthria, right-sided ataxia, and right eye exotropia. CT angiography identified vasospasm at the basilar tip, with subsequent MRI demonstrating an infarction of the midbrain. The patient was admitted, underwent aggressive fluid resuscitation, and then discharged after vitals had stabilized and ambulation and speech had improved. Incomplete right eye convergence resolved by the 3-month follow-up.

Lessons: The authors present a rare case of cerebral vasospasm following transsphenoidal resection of a pituitary macroadenoma and discuss the effect on midbrain tracts involved in vergence. https://thejns.org/doi/10.3171/CASE25453.

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