Laparoscopic anterior lumbar interbody fusion precipitating pituitary apoplexy

Objective. Pituitary apoplexy may be the first presentation of a previously undiagnosed pituitary adenoma. Although many mechanisms of pituitary apopl exy have been proposed in the literature, the exact pathogenesis remains un clear. Many predisposing events have been implicated in the pathogenesis, h owever, the role of laparoscopy precipitating pituitary apoplexy has not be en previously described. The authors present a case of pituitary apoplexy i n a previously undiagnosed pituitary adenoma, which presented in the immedi ate post-operative period after a laparoscopic anterior lumbar interbody fu sion. Clinical Presentation. A 45-year-old man presented with a sudden onset of h eadache, photophobia, diplopia, visual field deficits, and decreased visual acuity in the immediate post-operative period after an uneventful laparosc opic anterior lumbar interbody fusion. Results of computed tomography of th e brain revealed a hyperdense suprasellar mass without any signs of subarac hnoid blood. The patient underwent magnetic resonance imaging, which reveal ed a hemorrhagic pituitary tumor with lateral and suprasellar extension, wi th compression of the cavernous sinus and optic chiasm, respectively. An ur gent transsphenoidal decompression of the hemorrhagic pituitary adenoma was performed. Post-operatively, the patient demonstrated marked neurological improvement with recovery of visual acuity and extraocular movements. Conclusion. To the authors' knowledge, this is the first case reported in t he literature of a laparoscopic procedure precipitating pituitary apoplexy. Recognition of this rare complication of laparoscopic surgery, and the imp ortance of rapid diagnosis and urgent surgical treatment are emphasized.