Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study.

BACKGROUND: The data on incidence of hypopituitarism after SAH are conflicting. Furthermore, it is still not known whether there is any difference in hormonal deficiencies between SAH due to anterior communicating artery (A-com) and middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: This study includes both retrospective and prospective arms. The data collected included baseline demographic profile, clinical severity on admission to the hospital by the Hunt and Hess grading system and World Federation of Neurological Surgeons (WFNS) grading, radiological severity of bleed by the Fisher's classification, and treatment details. All the patients underwent detailed hormonal evaluation at baseline and 6 months in prospective group while at the end of 1 year in the retrospective group. Hormonal deficiencies between patients with A-com and MCA aneurysmal SAH were compared using appropriate statistical tests. RESULTS: Of 60 patients studied, 47 patients (A-com: 28 and MCA: 19) were in the retrospective group, while 13 patients (A-com-9, MCA-4) were in the prospective group. The baseline data were comparable between the two groups. At or after 6 months follow-up, 19 (31.6%) patients, 10 patients with A-com and 9 patients with MCA aneurysmal SAH, had some form of hormone deficiency. Furthermore, there was no difference in endocrine dysfunctions between the two groups. There was no correlation between the severity of hormonal deficiency and the clinical severity of SAH grade by Hunt and Hess and radiological grade of SAH by Fisher's grade. CONCLUSION: Hormonal deficiencies are not uncommon in patients with SAH. There is no difference in hormonal deficiencies and severity of hypopituitarism in patients with SAH due to A-com and MCA bleed.

Megacraniectomy for Malignant Intracranial Hypertension: No Time for Caution.

Malignant intracranial hypertension (IHT) intracranial tension (ICT) is a surgical emergency. Routine decompressive craniectomy may not be sufficient in reducing the malignant IHT. At present, we do not have the exact solution to this ominous situation. Authors came across a similar scenario where we had to go forward with modification of a previously known described procedure, removing bifrontal, temporal, and parietal bones including midline bone strip over a superior sagittal sinus in a case of resistant malignant ICT, following coiling of an anterior communicating artery aneurysm. This radical technique, named as megacraniectomy, was used as a last resort in a rapidly deteriorating patient. The patient survived the stormy phase of malignant ICT and showed significant improvement in neurological status. Authors here describe this approach as a novel idea to be explored in resource-stricken situations.