Post-operative hemorrhage after transsphenoidal surgery in patients with pituitary adenoma:a retrospective analysis

LIANG Qiang; CHEN Juxiang; LUO Chun; HU Guohan; YAN Yong; XU Tao; QIAN Jun; JIANG Lei; LU Yicheng

Abstract：Objective The possible causes, management and prognosis of post-operative hemorrhage after transsphenoidal surgery in patients with pituitary adenoma are discussed.Methods Among 876 consecutive cases with pituitary adenoma undergone transsphenoidal surgery, post-operative hemorrhage occurred in 17 cases.The clinical data were analyzed retrospectively and discussed with the related literatures.Results In all 11 cases with intrasella hemorrhage, six hemorrhagic cases were due to residual tumor bleeding and 5 cases due to intrasella overpacking of hemostasis materials.In nine cases underwent hematoma evacuation, 7 cases got good recovery of visual acuity and 2 cases remained unilateral visual impairment.Four cases were related to residual tumor bleeding into subarachnoidal space through the ruptured diaphragma sellae and 2 cases probably related to rapid collapse of diaphragma sellae intra-operatively in 6 cases with suprasella hemorrhage.The hematoma evacuation by craniotomy were performed in all 6 cases, and 1 case got recovery of visual acuity, 1 case got complete recovery of consciousness, 1 dead case and 3 cases remained coma status.Conclusion Both post-operative intrasella and suprasella hemorrhage after transsphnoidal surgery for pituitary adenomas should be considered as severe complications and need appropriate management as soon as possible.Patients with intrasella hemorrhage often have favorable prognosis after prompt evacuation of hematomas.The patients with suprasella hemorrhage, however, usually get a poor prognosis which indicates the prophylaxis is of great importance.