The most important thing to prevent SAH following transsphenoidal surgery is to protect arachnoid membrane which locates between pituitary adenoma and intracranial tissues. Once obvious leakage of CSF occurs, which implies arachnoid membrane is breached, more attention should be paid and cause of the leakage should be found. Instant repair and complete haemostasis should be done, especially in case of haemorrhage from the residual tumour (Zhou and Yang 2009). For bleeding from anterior intercavernous sinuses, bleeding could be stopped by local gelatin sponge compression.

Pituitary tumour should never be pulled by force. Two-stage operation or transcranial approach might be adopted if necessary. Microsurgical procedure or endoscopic transsphenoidal surgery should be performed by skilled surgeons who are familiar with topography of sellar area and transsphenoidal procedures. Previous researchers suggested that experience is vital to avoid complications of transsphenoidal surgery (Ni et al. 1994; Long et al. 1996; Kitano and Taneda 2008).

While residual tumour bleed is confirmed, intrasellar haematoma might be removed by transsphenoidal reoperation. For suspected SAH, early diagnosis and early treatment are important. Cerebral vasodilator, neuronal protectors, anti-vasospasm treatment should be instituted as early as possible (Kasliwal et al. 2008). Antiepileptics should be given to prevent seizure in patients with SAH. For those with severe SAH, calcium-channel blockers, such as nimodipine, should be given via intravenous transfusion for 7–10 days (using micropump). Continuous CSF drainage might be adopted in those patients without obviously increased intracranial pressure. Drainage may be performed by ventricular or lumbar puncture by inserting an indwelling catheter for 3–5 days (drain 70–100 ml/day). Once severe vasospasm is caused by SAH, leading to extensive cerebral infarction, craniotomy and decompression procedures may be necessary. If blood enters the ventricular system and causes acute obstructive hydrocephalus, instant ventricular drainage should be performed to lower the intracranial pressure (Zhou and Yang 2009).