Bilateral thalamic infarction following transsphenoidal surgery.

The transsphenoidal approach is widely employed for access to surgical lesions of the sella. Following the introduction of the operating microscope to the procedure by Hardy,1 it has become a safe and well-established operation, as demonstrated by the low morbidity and mortality in several large case series over the past four decades.2-6 Nevertheless, rare but serious complications, most notably injury to the intracavernous carotid artery7,8 and post-operative meningitis,9 do occur and have been well-documented. In this article we present, to our knowledge, the first reported case of bilateral thalamic infarction occurring as a serious complication of transsphenoidal surgery for resection of a pituitary adenoma. We also briefly review the pathogenesis of bilateral thalamic infarctions, and discuss the intraoperative factors unique to this case and to the transsphenoidal approach which may have contributed to this unusual complication.