Details

Autor(en) / Beteiligte

• Dalvi, Nagma
• Jacob, Cimy
• Karkare, Shefali

Titel

PT-03PROLONGED VASOSPASM FOLLOWING POSTERIOR FOSSA TUMOR RESECTION- A CASE REPORT

Ist Teil von

• Neuro-oncology (Charlottesville, Va.), 2014-11, Vol.16 (Suppl 5), p.v175-v175

Ort / Verlag

Oxford University Press

Erscheinungsjahr

2014

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Cerebral Vasospasm Syndrome after tumor resection has not been well described in the pediatric population. It is a frequent complication after subarachnoid hemorrhage in adults and few case reports have discussed it following resection of pituitary/sellar tumors. There are only 3 reported pediatric cases in the literature. Usual onset of symptoms occurs at a mean of 8 days postoperatively involving mainly the anterior circulation. We report our experience of a 17-year-old boy who developed recurrent diffuse cerebral vasospasm that lasted 6 weeks after surgery. The patient was diagnosed with a left cerebellar grade IV medulloblastoma and underwent subtotal resection with no major operative complications. 2 weeks after surgery, he developed worsening of focal weakness and expressive aphasia that progressed to lethargy, bradycardia and decreased brainstem reflexes. Magnetic resonance imaging (MRI) showed acute ischemia in the frontoparietal, right occipital, and right medial temporal lobe. Subsequent magnetic resonance angiography two days later showed narrowing of left internal carotid and basilar artery with beading. The spasm progressed the following day to involve the Circle of Willis territories bilaterally. An external ventricular drain was placed and steroids, triple therapeutic hypervolemia, hypertension, and hemodilution therapy, and intrathecal nicardipine were started. His vasospasm improved 10 days later but he developed posterior reversible encephalopathy syndrome secondary to the treatment. As he was weaned off therapy, he became symptomatic again and was found to have a recurrence of vasospasm. His symptoms and MRI vasospasm gradually resolved and at 8 weeks after surgery he was discharged with stable initial postoperative deficits. This is one of the first pediatric cases to describe vasospasm lasting 6 weeks following a posterior fossa tumor resection. The prolonged course of this patient's symptoms shows the importance of early recognition with a high index of suspicion and aggressive treatment of vasospasm in the initial phase.