Vasospasm following transsphenoidal tumor removal associated with the arterial changes of oral contraception.

A case of fatal cerebral vasospasm after transsphenoidal removal of a pituitary macroadenoma with suprasellar extension is reported. On the second postoperative day the patient developed headache, lethargy, and cardiorespiratory arrest. Five days later, after recovery from this episode, she developed signs of involvement of the left hemisphere. At that time she demonstrated severe cerebral vasospasm, which was worse in the left supraclinoid segment of the internal carotid artery, and she died 19 days postoperatively. Postmortem examination showed left hemispheric and hypothalamic infarction with subsequent herniation. In addition, pathologic arterial changes usually related to use of oral contraceptives were present.