BRAIN-STEM HEMORRHAGE DURING TRANSSPHENOIDAL SURGERY - POSSIBLE RISK OF THE MANEUVER OF INCREASING THE ENDEXPIRATORY PRESSURE IN A CASE OF PITUITARY-ADENOMA ASSOCIATED WITH DURAL ARTERIOVENOUS MALFORMATION - CASE-REPORT

The authors report a case of pituitary adenoma associated with dural a rteriovenous malformation (AVM), which caused brain stem haemorrhage d uring transsphenoidal surgery. The manoeuvre of increasing the endexpi ratory pressure in order to push the suprasellar component of the aden oma down to the sella turcica could be the reason of this bleeding. Th e authors therefore recommend that in cases of such a combination any manoeuvres which are likely to increase the intracranial venous pressu re or otherwise affect the intracranial pressure, are avoided. The dur al AVM spontaneously regressed after haemorrhage.