Cerebral vasospasm following tumor resection: Illustrative cases and review of the literature

Background: Cerebral vasospasm (CV) after tumor resection is a rare event, although it is associated with poorer postoperative outcomes and increased morbidity and mortality. Given the potential for neurologic injury secondary to CV, there is a need for further understanding of this phenomenon. Therefore, the purpose of this study is to investigate the risk factors of CV following intracranial tumor resection.

Methods: A literature review was conducted identifying 61 studies (40 individual case reports, 14 case series, and 7 cohort studies) reporting 179 individual cases. Additionally, two illustrative cases were presented.

Results: Post-tumor resection CV was reported more often in males (58.0 %) than females (42.0 %), with an average age of onset of 47.3 years in males compared to 40.4 years in females. Of those specified, CV most commonly occurred in posterior fossa tumors (51.8 %), followed by the sellar/suprasellar region (36.6 %). The most common pathologies were schwannoma (31.8 %), pituitary adenoma (27.8 %), meningioma (15.2 %), and craniopharyngioma (9.9 %). Vasospasm most commonly occurred diffusely in the anterior circulation (60.2 %), with MCA and ACA involvement indicated in 72.7 % and 64.8 % of all cases, respectively. Symptomatically, CV most commonly presented with altered mental status (73.9 %) or weakness (60.9 %), specifically hemiparesis (37.0 %) or altered consciousness (22.8 %). Most cases of vasospasm presented within the first week (58.4 %), with 97.7 % occurring within the first 2 weeks. A higher mortality rate was associated with onset before 3 days (n=6/13; 46.2 %). Mortality was reported in 17.3 % (n=18) of all cases and residual deficits were reported in 53.5 % (n=46) of those patients who survived.

Conclusion: Most reports on CV involved posterior fossa tumors, the anterior circulation (most frequently the MCA), and tumors of varying histologies. Tumor location and vascular involvement may be related to distribution of spasm and symptomatology. Early onset of vasospasm may furthermore be related to poorer outcomes.