Diffuse vasospasm after transcortical temporal lobectomy for intractable epilepsy

Abstract

Cerebral delayed ischemia due to arterial vasospasm is a rare complication following epilepsy surgery. Here we report the third known case and first of diffuse vasospasm. A 48-year-old woman underwent a transcortical anterior left temporal lobectomy. Eleven days later, she had new-onset expressive aphasia with narrowing of the anterior, middle, and posterior cerebral arteries, and increased velocities via transcranial Doppler. She was treated with fluids, nimodipine, and permissive hypertension. At 6 months, her speech was near baseline. Cerebral vasospasm may represent a rare cause of morbidity after anterior temporal lobectomy; a literature review on the subject is presented.

Symptomatic cerebral vasospasm in the setting of carmustine wafer placement for glioblastoma: A case presentation and review of literature

“…sCVS occurred immediately after surgery in the case described by Muzii et al and likely follows the course of sCVS secondary to manipulation. [7,11,19,21,28,29] Given the fact that, the peak effect of carmustine wafers occurs around day 5-7 after implantation, [13,14,26] a delayed course of vasospasm as displayed in our case and the case presented by Nakada et al seems more likely to follow the pathogenesis. [22] erefore, the delayed onset of symptoms in future cases of Gliadel placement should raise suspicion of this phenomenon for clinicians.…”

“…e delayed timing of the sCVS does not match the course of "traction hemiplegia, " which tends to manifest as CVS intraoperatively or immediately in the perioperative course and is short termed. [7,11,19,28,29] Although there was a minimal amount of hemorrhage within the posterior and medial aspects of the operative bed, there was no evidence of postoperative subarachnoid hemorrhage or hemorrhage within the basal cisterns. Lackner et al implicated high bleeding volume on postoperative CT in the development of sCVS.…”

“…CVS is a well-described entity in patients with aneurysmal subarachnoid hemorrhage (aSAH) [4,8,10,34] and following epilepsy surgery, [11,19,20,24] but its incidence in the postoperative course of tumor resection is low. [7] Bejjani et al conducted a retrospective review of 470 patients with skull base tumors and noted 1.9% incidence of CVS postoperatively.…”