Vasospasm after resection of brain tumours

B. Pettorini, S. Parlato, J. Yousaf, B. Pizer, S. Avula, R. Kumar, C. Mallucci

Introduction: Diffuse cerebral vasospasm after brain tumor resection is rare. Diffuse cerebral vasospasm is a frequently observed complication following aneurysmal subarachnoid hemorrhage or after severe traumatic head injury. In the last several years, there have been an increasing number of cases of symptomatic cerebral vasospasm following intracranial tumor resection. Various etiologies as to the cause of vasospasm after brain tumor resection have been described, such as significant intraoperative bleeding, tumor location, operative positioning, tumor pathology, vascular manipulation, release of vasoactive factors, and post- operative blood in the basal cisterns.

In this study, we report three cases of delayed symptomatic vasospasm following resection of brain tumours. A review of the current literature and pathophysiology is discussed.

Method: Three paediatric patients were identified who suffered from delayed symptomatic vasospasm following resection of brain tumours (2 girls, 1 boy; median age 7.1 years). Hospital records were reviewed regarding history, presenting features, physical examination, treatment and radiological findings.

Results: Three patients who underwent resection of brain tumour (1 vestibular schwannoma, 1 posterior fossa pylocytic astrocytoma, 1 supratentorial astrocytoma) developed delayed neurological symptoms (median 6 days after surgery). MRI and MRA showed cerebral vasospasm. Treatment involves elevation of the blood pressure (induced hypertension), hemodilution to improve cerebral blood flow, and maintenance of high normal circulating blood volume (hypervolemia).

All patients recovered back to their post-operative baseline and MRA showed complete resolution of the vasospasm.

Conclusions: Neurologic deterioration in the post-operative period following tumor resection, unexplained by other causes, could suggest possible vasospasm. Early recognition and prompt treatment using triple-H can significantly improve patient outcome.

ONCOLOGY