Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA; Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA.
Clin Neurol Neurosurg. 2024 Nov;246:108590. doi: 10.1016/j.clineuro.2024.108590. Epub 2024 Oct 10.
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.
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.
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.
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.
脑肿瘤切除术后的血管痉挛（CV）虽然与术后转归较差以及发病率和死亡率增加有关，但较为罕见。鉴于 CV 可能导致神经损伤，因此需要进一步了解这一现象。因此，本研究旨在探讨颅内肿瘤切除术后 CV 的危险因素。
通过文献回顾，确定了 61 项研究（40 例个案报告、14 例病例系列和 7 项队列研究），共报告了 179 例病例。此外，还提供了两个示例案例。
报道显示，男性（58.0%）较女性（42.0%）更易发生肿瘤切除术后 CV，男性的平均发病年龄为 47.3 岁，而女性为 40.4 岁。具体而言，CV 最常见于后颅窝肿瘤（51.8%），其次是鞍区/鞍上区（36.6%）。最常见的病理类型为神经鞘瘤（31.8%）、垂体腺瘤（27.8%）、脑膜瘤（15.2%）和颅咽管瘤（9.9%）。血管痉挛最常弥漫性发生在前循环（60.2%），MCA 和 ACA 受累分别占所有病例的 72.7%和 64.8%。症状性 CV 最常见的表现为精神状态改变（73.9%）或无力（60.9%），特别是偏瘫（37.0%）或意识改变（22.8%）。大多数 CV 病例发生在术后第一周内（58.4%），97.7%发生在术后 2 周内。发病时间在 3 天内（n=6/13；46.2%）与较高的死亡率相关。17.3%（n=18）的病例报告了死亡率，存活患者中有 53.5%（n=46）报告有残留缺陷。
大多数关于 CV 的报道涉及后颅窝肿瘤、前循环（最常为 MCA）和各种组织学肿瘤。肿瘤位置和血管受累可能与痉挛分布和症状学有关。CV 早期发病可能与较差的预后有关。
