Symptomatic Cerebral Vasospasm Following Resection of a Medulloblastoma in a Child

Abstract

This case illustrates an unusual complication of posterior fossa tumor resection, and the potential utility of TCD studies in the detection and management of vasospasm in pediatric neurocritical care.

Cerebral Vasospasm after Open Fenestration of an Arachnoid Cyst in a 4-Year-Old Boy: Case Report and Review of the Literature

“…Adult CVS has been reported following open and endoscopic tumor resection [6-11, 13, 16, 20-24] and after rupture or resection of colloid and dermoid cysts [25, 26]. The suspected vasospasm triggers discussed in these cases include chemical meningitis [9, 11, 24, 27], intraoperative bleeding, subarachnoid blood, intracranial hypotension, vasoactive tumor antigens, intraoperative vessel manipulation, and Gelfoam [19].…”

“…The suspected vasospasm triggers discussed in these cases include chemical meningitis [9, 11, 24, 27], intraoperative bleeding, subarachnoid blood, intracranial hypotension, vasoactive tumor antigens, intraoperative vessel manipulation, and Gelfoam [19]. …”

“…As the etiologies and risk factors for vasospasm after arachnoid cyst fenestration or tumor resection are not well defined, it would not be productive to discuss potential prevention until more is known. Moreover, there is no standard of care for pediatric vasospasm [24, 29]. While adult aSAH vasospasm protocols are well-substantiated, evidence for their safety and efficacy in pediatric patients is limited [24, 29].…”

“…Moreover, there is no standard of care for pediatric vasospasm [24, 29]. While adult aSAH vasospasm protocols are well-substantiated, evidence for their safety and efficacy in pediatric patients is limited [24, 29]. In one retrospective series, 12 pediatric aSAH patients receiving oral nimodi­pine at a mean dose of 1 mg/kg every 4 h experienced frequent hypotension [29].…”

Time-Dependent Structural Changes of the Dentatothalamic Pathway in Children Treated for Posterior Fossa Tumor

“…26 The DTT tract is the main outflow of the cerebellum, and it has been suggested that injury to the cerebellum and degeneration of this cerebrocerebellar pathway may be involved in cognitive dysfunction and PFS. 13,[27][28][29] More recently, DTI metrics have shown tensor changes in the DTT pathway in patients treated for PF tumor, suggesting that DTI may be more robust than conventional MR imaging in probing structural damage. 12,13,16,30 While prior studies have reported decreased FA of the SCP or increased MD of the cerebellar white matter in patients with PFS when examined at variable single-time points, our results show that the tensor changes may not be limited to those with symptoms of PFS.…”