Abstract
Cerebral vasospasm leading to delayed cerebral ischemia is an uncommon but life-threatening complication of the endoscopic endonasal approach (EEA), which could cause devastating neurological sequelae. Herein, we report the case of a 59-year-old female with a medical history of poorly controlled type 2 diabetes mellitus, high blood pressure, dyslipidemia, and allergy to penicillin, who presented with left eye amaurosis and right temporal hemianopsia, for which a magnetic resonance imaging (MRI) was requested, revealing a pituitary macroadenoma of approximately 3.39 x 3.43 x 3.15 cm. Surgical management was indicated for resection of the tumoral lesion by endoscopic endonasal approach. A postoperative MRI and computed tomography (CT) were performed due to severe deterioration of visual acuity and disorientation in time and place, showing supratentorial subarachnoid hemorrhage in addition to vasogenic edema in the perioperative frontal region. A subsequent magnetic resonance angiography (MRA) revealed acute fronto-cingulate ischemia in the territory of both anterior cerebral arteries (ACA). Management with nimodipine and triple H therapy was initiated, in addition to strict neurological follow-up. The patient also required follow-up and management by endocrinology due to the development of diabetes insipidus. Subsequent imaging confirmed reperfusion of both ACAs; however, the patient was discharged 40 days after surgery with persistent impairment in higher mental functions, including temporal disorientation, bradyphrenia, and operative and episodic amnesia. This is a rare complication, but strict postoperative follow-up aids in timely suspicion to provide indicated treatment, reducing sequelae and improving neurological outcomes.
