Intracranial vasospasm with delayed ischaemic deficit following epidermoid cyst resection

Abstract

ABSTRACT. Intracranial vasospasm following surgical removal of intracranial tumours is rare. To our knowledge there have been no previously reported cases of delayed vasospasm occurring post debulking of epidermoid cysts. We report a case in which vasospasm led to established cerebral infarction 2 weeks postoperatively. MRI and serial magnetic resonance angiography (MRA) reliably show initial multiple stenoses in the vertebral and internal carotid arteries followed by their spontaneous normalisation. MRA imaging is now of sufficient quality to enable it to be a safe and effective means of both looking for vasospasm and monitoring its resolution.

Cerebral vasospasm following tumor resection

“…Meningiomas are commonly found in this location and can parasitize branches of the internal carotid artery making these vessels prone to injury due to excessive surgical manipulation 46. Posterior fossa lesions are uncommonly associated with postoperative vasospasm with only nine reported cases 2 4 8 9 13 17 19 20 36. Interestingly, posterior fossa tumors tend to cause diffuse vasospasm,9 17 19 20 rather than localized vasospasm involving vessels around the surgical site which is usually the case for vasospasm complicating resection of sellar and middle fossa lesions (figure 1).…”

“…Vasospasm observed following spontaneous rupture of dermoid cysts53 and craniopharyngiomas54 strongly suggests that specific tumor pathology can be an important factor in some cases of postoperative vasospasm 4 14 35. Tumors can induce vasospasm by release of lipid metabolites14 or by altering intracellular calcium levels with certain growth factors 12.…”

Delayed ischaemia due to vasospasm after fenestration of a large arachnoid cyst

“…1 After brain tumour removal, several mechanisms have been postulated in the pathogenesis of vasospasm: accumulation of blood in the basal cisterns, manipulation or damage of blood vessel walls, and release of tumour material. 2 A number of studies specifically reported on vasospasm after resection or rupture of an intracranial cyst (craniopharyngioma, colloid cyst, dermoid tumour). 3 It is suggested that in these cases the content of the cyst caused a sterile inflammation, which subsequently led to the vasospasm.…”

“…Interestingly, a similar time course (1-2 weeks) is reported in the literature for patients that clinically declined due to vasospasm after removal of a tumour or colloid cyst. 2,3 We considered alternative explanations. Post-traumatic vasospasm is not seen in patients with a GCS >12 and a normal CT (i.e.…”

Symptomatic Anterior Cerebral Artery Vasospasm after Brainstem Hemangioblastoma Resection

“…Transcranial Doppler and angiographic studies demonstrated a diffuse vasospasm involving bilaterally both middle cerebral arteries, both proximal posterior cerebral arteries, with a major expression on the right anterior Tumours of the sellar region are the most common pathologies associated with this complication likely due to the distinctive anatomical relationship with the major arteries. Only nine posterior cranial fossa lesions resected are described in association with delayed symptomatic vasospasm [3][4][5][6][7][8][9][10][11] . In our case, the predominant role seems to be played by the amount of blood shed during surgery in the basal cisterns, demonstrated by post-operative CT.…”