Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Transsphenoidal Resection of a Craniopharyngioma

Ricarte, Irapuá Ferreira; Funchal, Bruno Ferreira; Alves, Maramélia Miranda; Gomes, Daniela Laranja; Valiente, Raul Alberto; Carvalho, Flávia Chiva; Silva, Gisele Sampaio

doi:10.1016/j.jstrokecerebrovasdis.2015.06.005

Cited by 17 publications

(19 citation statements)

References 10 publications

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“…Other theories postulate acute rise in blood flow due to systemic hypertension or physical activity, reduction of vascular flux caused by surgery, radiotherapy or post intrathecal anesthesia. Molecular evidence shows abnormal expression of VEGF mRNA, coagulation disturbances such as thrombocytopenia or pharmacological anticoagulation, pregnancy, diabetes mellitus, estrogen replacement therapy, dopamine agonist therapy, sickle cell anemia, lymphocytic leukemia and head trauma in an another hang [2,6]. Differential diagnoses include meningitis, subarachnoid hemorrhage, midbrain infarction, cavernous sinus thrombosis, hemorrhagic infarction in a Rathke's cleft cyst and aneurysms [2].…”

Section: Discussionmentioning

confidence: 99%

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Recurrent craniopharyngioma with extensive necrosis and epithelial reactive changes: Are we facing apoplexy driven by premalignant changes? Two case reports

Tena-Suck¹,

Ortíz-Plata²,

Macías³

et al. 2020

J Histol Histopathol

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Pituitary apoplexy is characterized by a sudden increase in pituitary gland volume secondary to ischemia and/or necrosis, usually occurring in the context of pituitary adenoma. Little is known about craniopharyngioma apoplexy. However, some cases have been reported, and it is usually an underused but necessary term in the presence of extensive necrosis and hemorrhage within Craniopharyngiomas. Here, we report two cases of craniopharyngioma apoplexy in a man aged 26 and a woman aged 30 years old, who presented this sellar tumor at an early age, both presenting recurrence and had previously undergone radiotherapy. In the previous recurrence, we observed histological findings related to extensive necrosis, fibrin thrombi, vascular damage and proliferation, inflammation, hemorrhage, fibrin foci, and epithelial reactive changes. Also, we observed pseudostratification, atypia and external epithelium pleomorphism, proliferation of the stellate reticulum with mitotic features as well. Strikingly, by immunohistochemistry, we described the overexpression of β-catenin only in loose cells found the middle of the extensive necrosis areas, displaying a high Ki67 index, found in its punctate form. Both cases showed the same histological pattern. Such findings hadn't been described in Craniopharyngiomas; we suggest that these are related to apoplexy, post radiation changes or premalignant transformation, reason why this could be termed carcinoma in situ or high-grade intraepithelial lesion. The 2016 WHO classification for CNS tumors update does not consider new features related to malignant transformation occurring in Craniopharyngiomas.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, radiation-induced vascular abnormalities are considered strong risk factors to malignant transformation and stroke. Early postoperative complications of CPs include evidence of hypothalamic or pituitary iatrogenic injury, hormonal insufficiency, metabolic changes, of seeding [6].…”

Section: Discussionmentioning

confidence: 99%

Recurrent craniopharyngioma with extensive necrosis and epithelial reactive changes: Are we facing apoplexy driven by premalignant changes? Two case reports

Tena-Suck¹,

Ortíz-Plata²,

Macías³

et al. 2020

J Histol Histopathol

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“…The treatment options for vasospasm following pituitary surgery include hemodynamic therapy, intra-arterial vasodilators, or angioplasty [ 5 , 7 ]. Medical management via hemodynamic therapy focuses on euvolemic hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Medical management via hemodynamic therapy focuses on euvolemic hypertension. However, in patients with diabetes insipidus, such therapy is challenging due to hypovolemia [ 7 ]. Although induction of a hypertensive state does not treat vasospasm, the cerebral blood flow is increased, helping to reduce ischemia.…”

Section: Discussionmentioning

confidence: 99%

Angioplasty is an Effective Treatment for Vasospasm Following Pituitary Apoplexy and Tumor Resection

Douleh¹,

Morone

Mobley

et al. 2018

Cureus

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Pituitary apoplexy is a clinical syndrome characterized by acute headache, visual changes, and decreased consciousness occurring in association with hemorrhage or infarct of an existing pituitary adenoma. Surgical management involves tumor resection and decompression of surrounding structures including the optic apparatus. Vasospasm is a rare but potentially devastating complication of pituitary apoplexy. We present a case of pituitary apoplexy in a 28-year-old male treated with emergent endoscopic transsphenoidal resection. On postoperative day seven, following surgical resection, the patient developed neurologic deficits and motor weakness, and severe vasospasm was diagnosed. This is a novel case of intra-arterial verapamil and angioplasty used to treat vasospasm following surgical decompression for pituitary apoplexy. The patient experienced complete recovery of motor deficits following treatment. The authors propose angioplasty as an effective treatment for postoperative vasospasm following transphenoidal surgery for pituitary apoplexy in the presence of focal vessel stenosis.

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“…Although the mechanism of post-TSS vasospasm is uncertain, postoperative SAH seems to be the most consistent risk factor. SAH has been observed in the majority of post-TSS vasospasm cases (84.6%) and is presumed to have a pathophysiological role, although vasospasm in the absence of SAH has been described [5][6][7][8]. Vasospasm is thought to be an infrequent contributor to the overall spectrum of ischemic complications after TSS, which includes direct injury to the internal carotid artery (ICA) and compression secondary to apoplexy [9].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review

Budnick

Tomlinson

Savage

et al. 2020

Cureus

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Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Transsphenoidal Resection of a Craniopharyngioma

Cited by 17 publications

References 10 publications

Recurrent craniopharyngioma with extensive necrosis and epithelial reactive changes: Are we facing apoplexy driven by premalignant changes? Two case reports

Recurrent craniopharyngioma with extensive necrosis and epithelial reactive changes: Are we facing apoplexy driven by premalignant changes? Two case reports

Angioplasty is an Effective Treatment for Vasospasm Following Pituitary Apoplexy and Tumor Resection

Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review

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