Cerebral Vasospasms Following Endoscopic Endonasal Surgery for Pituitary Adenoma Resection in the Absence of Post-Operative Subarachnoid Hemorrhage

The endoscopic endonasal approach (EEA) is a widely accepted and commonly utilized approach for the resection of various pituitary tumors. While complications commonly include diabetes insipidus, cerebrospinal fluid leaks, and anterior lobe insufficiency cerebral vasospasm may also rarely occur. Herein, we report the unique case of a 44-year-old female who underwent uncomplicated endoscopic endonasal surgery for resection of a giant pituitary adenoma. Subsequent cerebral vasospasms were identified on postoperative day 3 and 19 resulting in ischemic strokes with neurological consequence. In the postoperative period, imaging at no point revealed any evidence of subarachnoid hemorrhage or hematoma formation in the subarachnoid space. Risk factors for cerebral vasospasm are discussed and the potential for subsequent vasospasm events is addressed.