Cerebral vasospasm following tumor resection.

OBJECTIVE

To perform a systematic review of the literature of cases of vasospasm following tumor resection and to discuss possible etiologies, diagnosis and management of this complication.

METHODS

A literature search was performed using relevant search key words to identify cases of 'cerebral vasospasm' as a complication following tumor resection. Articles were identified by searching MEDLINE and PubMed databases. Relevant cross references were added by manually searching the references of all retrieved articles.

RESULTS

There were a total of 56 patients in our initial search but only 40 cases matched our inclusion criteria. Pituitary tumors and sellar area were the most common pathologies and location associated with this complication. Average time interval to development of symptomatic vasospasm was 8 days and mortality was high (30%). The most common encountered causative factors were vascular factors (vessel encasement, displacement and narrowing) and presence of blood in the basal cisterns in postoperative scans.

CONCLUSIONS

'Cerebral vasospasm' after tumor resection is a rare but challenging complication with very high morbidity and mortality in reported cases. Vasospasm following brain tumor surgery shares some of the same clinical variables (time interval, causative factors, morbidity and death rates) of vasospasm after aneurysmal subarachnoid hemorrhage. A high index of suspicion is required for early diagnosis and prompt management which are key elements of final outcome.