Diffuse cerebral vasospasm after resection of schwannoma: a case report

Abstract

BackgroundThe etiology of vasospasm after brain tumor resection remains unclear. This is the first report of diffuse cerebral vasospasm following resection of a schwannoma located in the left portion/part of the ventral medulla oblongata.Case presentationA 16-year-old boy presented with dizziness and projectile vomiting without apparent cause three months before admission. Magnetic resonance imaging revealed a space-occupying lesion in the left portion of the ventral medulla oblongata. The tumor was completely resected. Pathological examination was consistent with diagnosis of schwannoma. Three days after surgery, the patient was in an unconscious state. Magnetic resonance angiography revealed the occurrence of cerebral vasospasm, with ischemic infarction and segmental cerebrovascular stenosis. Seven days after surgery, dehydration therapy was carried out and decompressive craniectomy was performed in the frontal and temporal areas. Despite treatments, the patient was in a persistent vegetative state after surgery, with normal vital signs.ConclusionThis was an uncommon occurrence of diffuse cerebral vasospasm following the resection of schwannoma. Appropriate management of this condition is uncertain, but aggressive treatments including expansion of blood volume and relief of spasm should be performed to treat postsurgery vasospasm.

Delayed symptomatic cerebral vasospasm following vestibular schwannoma resection: illustrative case

“…Most patients with cerebral vasospasm after posterior fossa schwannoma excision were young, with 4 of 5 being younger than 40 years of age. 3 , 5 , 7 , 8 However, as in our case, 1 patient with vestibular schwannoma excision was 69 years old, and the author also described the tumor as having a cystic component. 6 Two cases were reported to have undergone a cerebrospinal fluid (CSF) diversion procedure before the tumor excision, and in 1 of the cases, the authors suggested a relative paucity of CSF in the cisterns as a predisposing factor for vasospasm.…”

“… 11 The direct mechanical trauma to the arterial wall during tumor resection can induce local artery vasoconstriction, which results in an intrinsic myogenic response, upregulated norepinephrine levels, or increased cerebrovascular reactivity to norepinephrine and serotonin. 8 Young people have enhanced contractility and elasticity of their arterioles, which can make them more susceptible to direct mechanical stress. In fact, the incidence of symptomatic vasospasm is lower among patients with aSAH who are older.…”

“… 1 Similarly, 1 patient had symptom onset at the 3rd day after surgery, in whom the direct mechanical trauma to the arterial wall during tumor resection was postulated as the cause. 8 …”

Predictors of Acute Vertebrobasilar Vasospasm following Tumor Resection in the Foramen Magnum Region

“…Posterior fossa tumors accounted for relatively less symptomatic vasospasm in comparison with anterior/middle fossa lesions after operation[ 7 , 20 ]. However, nearly all types of tumor in the posterior fossa can be encountered to be associated with cerebral vasospasm[ 3 , 21 – 24 ]. Moreover, it was revealed that more than half of patients with acoustic neurinomas presented anterior circulation vasospasm postoperatively[ 6 ].…”

Alterations in the expression of protease-activated receptor 1 and tumor necrosis factor-α in the basilar artery of rats following a subarachnoid hemorrhage

“…The most common predisposing factor for vasospasm onset following intracranial tumor resection is SAH ( 4 ). Blood accumulation in the basal cisterns is thought to be an important factor in initiating the vasospasm ( 5 ).…”