Hemostasis through Extended Transsphenoidal Route for Subarachnoid Hemorrhage after Conventional Transsphenoidal Surgery for a Pituitary Adenoma

Haruko YOSHIMOTO; Shozo YAMADA; Hideki SHIRAMIZU; Masataka KATO; Atsushi ISHIDA; Hikari SATO; Ko NAKASE; Yusuke SASAKI; Masahiro HIRAYAMA; Seigo MATSUO

doi:10.2176/nmccrj.cr.2020-0347

Case Reports

Hemostasis through Extended Transsphenoidal Route for Subarachnoid Hemorrhage after Conventional Transsphenoidal Surgery for a Pituitary Adenoma

Haruko YOSHIMOTO, Shozo YAMADA, Hideki SHIRAMIZU, Masataka KATO, Atsushi ISHIDA, Hikari SATO, Ko NAKASE, Yusuke SASAKI, Masahiro HIRAYAMA, Seigo MATSUO

Author information

Haruko YOSHIMOTO
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Shozo YAMADA
Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan
Hideki SHIRAMIZU
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Masataka KATO
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Atsushi ISHIDA
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Hikari SATO
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Ko NAKASE
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Yusuke SASAKI
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Masahiro HIRAYAMA
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Seigo MATSUO
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan

Keywords: transsphenoidal surgery, subarachnoid hemorrhage, hypothalamic artery, tumor adhesion, tethering effect

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Supplementary material

2021 Volume 8 Issue 1 Pages 545-549

DOI https://doi.org/10.2176/nmccrj.cr.2020-0347

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Abstract

This report describes a 49-year-old male patient who presented with a pituitary adenoma extending to the suprasellar region. Subarachnoid hemorrhage (SAH) occurred after conventional transnasal transsphenoidal surgery for a non-functioning pituitary adenoma despite no suprasellar arachnoid membrane breakdown. Through extended transsphenoidal route, the suprasellar hematoma was removed and bleeding from a small vessel thought to be the branch of left superior hypophyseal artery was successfully controlled. Indeed, several case reports regarding this rare complication have been published, but the mechanism of SAH has never been identified and the prognosis was poor in most cases. This report illustrates the origin and mechanism of the bleeding clearly using the intraoperative video. This case suggests that immediate therapeutic intervention is necessary and extended transnasal transsphenoidal repeat surgery is useful for an appropriate hemostasis and removal of hematoma located in the suprasellar region.

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