Kinoshita Yusuke, Sato Kenichi, Ito Tamio, Nakamura Hirohiko
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
World Neurosurg. 2020 Nov;143:97-101. doi: 10.1016/j.wneu.2020.07.137. Epub 2020 Jul 27.
The development of diffuse cerebral vasospasm after the removal of a brain tumor is extremely rare. We report a case of cerebral vasospasm after the removal of a posterior fossa hemangioblastoma.
A 62-year-old woman presented with a 1-month history of vertigo and nausea. Neurologic examination revealed that she was alert, with no paresis, and a mild left-sided cerebellar ataxia. Contrast-enhanced magnetic resonance imaging showed a cystic lesion with a strongly enhancing nodule, measuring 20 × 26 mm in diameter, in the cerebellar dorsal vermis. Angiography revealed that the lesion had feeding arteries from the left posterior inferior cerebellar artery. A diagnosis of hemangioblastoma was suspected and surgery was performed. On the first postoperative day, paresis of the right-sided extremities occurred. Diffusion-weighted imaging showed a high-intensity area in the medial side of the left frontal lobe. Magnetic resonance angiography indicated diffuse cerebrovascular stenosis. Considering these findings to be caused by vasospasm, we started the treatment used for vasospasm secondary to aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography on the 13th postoperative day revealed an improvement in the cerebrovascular stenosis. In this case, it appears that the cause of vasospasm was intraoperative spillage of the contents of the cyst.
Although the occurrence of diffuse cerebral vasospasm after the removal of brain tumors in the posterior fossa is rare, this complication should be noted as a potential postoperative complication after tumor removal; this should lead to earlier diagnosis and treatment and a potentially better prognosis.
脑肿瘤切除术后发生弥漫性脑血管痉挛极为罕见。我们报告一例后颅窝血管母细胞瘤切除术后发生脑血管痉挛的病例。
一名62岁女性，有1个月的眩晕和恶心病史。神经系统检查显示她意识清醒，无麻痹，左侧轻度小脑性共济失调。增强磁共振成像显示小脑蚓部背侧有一个直径20×26mm的囊性病变，伴有一个明显强化的结节。血管造影显示该病变由左小脑后下动脉供血。怀疑为血管母细胞瘤并进行了手术。术后第一天，右侧肢体出现麻痹。弥散加权成像显示左侧额叶内侧有一个高强度区域。磁共振血管造影显示弥漫性脑血管狭窄。考虑到这些发现是由血管痉挛引起的，我们开始采用治疗动脉瘤性蛛网膜下腔出血继发血管痉挛的方法进行治疗。术后第13天的磁共振血管造影显示脑血管狭窄有所改善。在该病例中，血管痉挛的原因似乎是术中囊肿内容物的溢出。
尽管后颅窝脑肿瘤切除术后发生弥漫性脑血管痉挛很罕见，但作为肿瘤切除术后潜在的并发症应予以关注；这应能实现早期诊断和治疗，并可能带来更好的预后。
