Almubaslat Mohammad, Africk Cynthia
Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA.
Surg Neurol. 2007 Sep;68(3):322-8; discussion 328. doi: 10.1016/j.surneu.2006.10.026. Epub 2007 Jun 21.
In the last 40 years, there were several reports of symptomatic cerebral vasospasm occurring after resection of brain neoplasms. In most cases, delay in recognition of this complication leads to significant neurologic deterioration postoperatively, regardless of the outcome of surgery. We illustrate in this report a case of cerebral vasospasm after resection of an esthesioneuroblastoma in an adult patient. This is the first report of vasospasm after resection of this neoplasm.
A 41-year-old woman presented with complaints of headache, dizziness, visual blurring, and diplopia of several-day duration. Funduscopic examination revealed papilledema. Radiological studies revealed a large frontal lobe mass extending through the cribriform plate into the ethmoid sinus with accompanying brain edema. The patient underwent a craniotomy for resection of the neoplasm. Pathological findings were consistent with a high-grade esthesioneuroblastoma. Eleven days postoperatively, the patient's neurologic status declined. Diffusion-weighted MRI of the brain showed an infarct involving mainly the left PCA as well as branches of the left anterior and middle cerebral arteries. Angiography revealed narrowing of the corresponding cerebral vessels consistent with vasospasm. Hypervolemic, hypertensive therapy with nimodipine and corticosteroids were instituted. The patient initially improved but was left with a right homonymous hemianopsia upon discharge 23 days postoperatively.
Delayed neurologic deficit from vasospasm after tumor resection is a complication that is being reported in increasing numbers. These cases involved tumors in or adjacent to the basal cisterns, or surgical approaches that increase the propensity of blood to accumulate intraoperatively or postoperatively in a specific pattern in the basal subarachnoid space. A high index of suspicion for vasospasm should be maintained in patients who develop delayed neurologic deficit, especially when there is evidence of profuse intraoperative bleeding or postoperative blood in the basal cisterns. Early recognition of this phenomenon and early institution of proper therapy can reverse some or all of the neurologic deficit and improve the overall outcome for these patients.
在过去40年里，有几篇关于脑肿瘤切除术后出现症状性脑血管痉挛的报道。在大多数情况下，无论手术结果如何，对这种并发症认识的延迟都会导致术后严重的神经功能恶化。在本报告中，我们阐述了一名成年患者在切除嗅神经母细胞瘤后发生脑血管痉挛的病例。这是该肿瘤切除术后发生血管痉挛的首例报告。
一名41岁女性主诉头痛、头晕、视物模糊和复视，持续数天。眼底检查发现视乳头水肿。影像学研究显示一个大的额叶肿块，穿过筛板延伸至筛窦，并伴有脑水肿。患者接受了开颅肿瘤切除术。病理结果与高级别嗅神经母细胞瘤一致。术后11天，患者神经功能状态下降。脑部弥散加权磁共振成像显示梗死灶，主要累及左侧大脑后动脉以及左侧大脑前动脉和大脑中动脉的分支。血管造影显示相应脑血管狭窄，符合血管痉挛表现。采用尼莫地平和皮质类固醇进行高血容量、高血压治疗。患者最初有所改善，但术后23天出院时仍遗留右侧同向性偏盲。
肿瘤切除术后血管痉挛导致的延迟性神经功能缺损是一种报告数量日益增多的并发症。这些病例涉及基底池内或其附近的肿瘤，或手术入路导致术中或术后血液以特定模式在基底蛛网膜下腔积聚的倾向增加。对于出现延迟性神经功能缺损的患者，应高度怀疑血管痉挛，尤其是当有术中大量出血或基底池内术后积血的证据时。早期识别这一现象并尽早进行适当治疗可逆转部分或全部神经功能缺损，改善这些患者的总体预后。
