Mikeladze Ketevan, Konovalov Anton, Bykanov Andrey, Vinogradov Evgeniy, Yakovlev Sergey
Vascular Department, Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia.
J Neurosurg Case Lessons. 2021 Mar 15;1(11):CASE20126. doi: 10.3171/CASE20126.
The authors report on four clinical cases with intraarterial verapamil administration to resolve vasospasm in patients who underwent surgery for intracranial tumors. Iatrogenic subarachnoid hemorrhage after tumor resection and subsequent vasospasm (an increase in the systolic linear velocity of blood flow through the M1 segment of the middle cerebral artery of more than 250 cm/sec; Lindegaard index: 4.1) were observed in four patients during the early postoperative period after the removal of intracerebral tumors. Each vasospasm case was confirmed by angiography data, was clinically significant, and manifested as the development of a neurological deficit.
Resolution of vasospasm with the intraarterial administration of verapamil was achieved in all four cases as confirmed by angiographic data in all four cases and complete regression of neurological symptoms in two cases. In all four presented cases, vasospasm was resolved; unfortunately, the resolution did not always lead to significant clinical improvement. However, lethal outcomes were avoided in two cases, and almost full recoveries were achieved in the other two.
The authors believe that the removal of intracranial tumors can cause expected and potential complications, such as cerebral vasospasm, which must be diagnosed and treated in a timely manner.
作者报告了4例颅内肿瘤手术后动脉内注射维拉帕米以缓解血管痉挛的临床病例。4例患者在脑肿瘤切除术后早期出现医源性蛛网膜下腔出血及随后的血管痉挛（大脑中动脉M1段血流收缩期线速度增加超过250 cm/秒；林德加德指数：4.1）。每例血管痉挛病例均经血管造影数据证实，具有临床意义，并表现为神经功能缺损的发展。
4例患者经动脉内注射维拉帕米后血管痉挛均得到缓解，4例血管造影数据均证实了这一点，2例患者神经症状完全消退。在所有4例病例中，血管痉挛均得到缓解；不幸的是，缓解并不总是能带来显著的临床改善。然而，2例避免了致命结局，另外2例几乎完全康复。
作者认为，颅内肿瘤切除可导致预期和潜在的并发症，如脑血管痉挛，必须及时诊断和治疗。
