### Patient Information
A 45-year-old man with no significant past medical history presented with persistent headaches and visual field deficits. Magnetic resonance imaging revealed a large pituitary macroadenoma measuring approximately 40 mm in maximum diameter, causing mild suprasellar extension and compression of the optic chiasm. Endocrinological evaluation showed nonfunctioning tumor characteristics. The patient was scheduled for transsphenoidal pituitary adenoma resection.
### Diagnosis
The patient underwent an uneventful standard endoscopic transsphenoidal resection of the pituitary macroadenoma. Intraoperative cerebrospinal fluid (CSF) leakage was noted and repaired. On postoperative day 7, the patient developed sudden right-sided hemiparesis and decreased level of consciousness. Neurologic examination revealed left middle cerebral artery territory deficits. Urgent neuroimaging with CT scan identified postoperative sellar hematoma and associated subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) demonstrated severe multifocal arterial vasospasm predominantly involving the anterior cerebral circulation.
The diagnosis of symptomatic arterial vasospasm following pituitary surgery was established based on clinical presentation, imaging evidence of vasospasm, and temporal relation to surgery and postoperative hemorrhage.
