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Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review.
Cureus. 2020 May 17; 12(5):e8171.C

Abstract

Cerebral vasospasm is a rare life-threatening complication of transsphenoidal surgery (TSS). We report our experience with two cases of symptomatic vasospasm after endoscopic TSS, alongside a systematic review of published cases. Two patients who underwent endoscopic TSS for resection of a tuberculum sella meningioma (case 1) and pituitary adenoma (case 2) developed symptomatic vasospasm. Clinical variables, including demographics, histopathology, the extent of subarachnoid hemorrhage (SAH), diabetes insipidus (DI), day of vasospasm, vasospasm symptoms, vessels involved, management, and clinical outcome, were retrospectively extracted. We subsequently reviewed published cases of symptomatic post-TSS vasospasm. Including our two cases, we identified 34 reported cases of TSS complicated by symptomatic vasospasm. Female patients accounted for 20 (58.8%) of 34 cases. The average age was 48.1 ± 12.9 years. The majority of patients exhibited postoperative SAH (70.6%). The average delay to vasospasm presentation was 8.5 ± 3.6 days. The majority of patients exhibited vasospasm in multiple vessels, typically involving the anterior circulation. Hemodynamic augmentation with hemodilution, hypertension, and hypervolemia was the most common treatment. Death occurred in six (17.6%) of 34 patients. Common deficits included residual extremity weakness (17.6%), pituitary insufficiency (8.8%), and cognitive deficits (8.8%). Symptomatic vasospasm is a rare, potentially fatal complication of TSS. The most consistent risk factor is SAH. Early diagnosis requires a high index of suspicion when confronted with intractable DI, acute mental status change, or focal deficits in the days after TSS. Morbidity and death are significant risks in patients with this complication.

Authors+Show Affiliations

Neurological Surgery, Indiana University, Indianapolis, USA.Neurological Surgery, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA.Neurological Surgery, Indiana University, Indianapolis, USA.Neurological Surgery, Indiana University, Indianapolis, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32566415

Citation

Budnick, Hailey C., et al. "Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review." Cureus, vol. 12, no. 5, 2020, pp. e8171.
Budnick HC, Tomlinson S, Savage J, et al. Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review. Cureus. 2020;12(5):e8171.
Budnick, H. C., Tomlinson, S., Savage, J., & Cohen-Gadol, A. (2020). Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review. Cureus, 12(5), e8171. https://doi.org/10.7759/cureus.8171
Budnick HC, et al. Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review. Cureus. 2020 May 17;12(5):e8171. PubMed PMID: 32566415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review. AU - Budnick,Hailey C, AU - Tomlinson,Samuel, AU - Savage,Jesse, AU - Cohen-Gadol,Aaron, Y1 - 2020/05/17/ PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline KW - delayed cerebral ischemia KW - transsphenoidal KW - tumor resection KW - vasospasm SP - e8171 EP - e8171 JF - Cureus JO - Cureus VL - 12 IS - 5 N2 - Cerebral vasospasm is a rare life-threatening complication of transsphenoidal surgery (TSS). We report our experience with two cases of symptomatic vasospasm after endoscopic TSS, alongside a systematic review of published cases. Two patients who underwent endoscopic TSS for resection of a tuberculum sella meningioma (case 1) and pituitary adenoma (case 2) developed symptomatic vasospasm. Clinical variables, including demographics, histopathology, the extent of subarachnoid hemorrhage (SAH), diabetes insipidus (DI), day of vasospasm, vasospasm symptoms, vessels involved, management, and clinical outcome, were retrospectively extracted. We subsequently reviewed published cases of symptomatic post-TSS vasospasm. Including our two cases, we identified 34 reported cases of TSS complicated by symptomatic vasospasm. Female patients accounted for 20 (58.8%) of 34 cases. The average age was 48.1 ± 12.9 years. The majority of patients exhibited postoperative SAH (70.6%). The average delay to vasospasm presentation was 8.5 ± 3.6 days. The majority of patients exhibited vasospasm in multiple vessels, typically involving the anterior circulation. Hemodynamic augmentation with hemodilution, hypertension, and hypervolemia was the most common treatment. Death occurred in six (17.6%) of 34 patients. Common deficits included residual extremity weakness (17.6%), pituitary insufficiency (8.8%), and cognitive deficits (8.8%). Symptomatic vasospasm is a rare, potentially fatal complication of TSS. The most consistent risk factor is SAH. Early diagnosis requires a high index of suspicion when confronted with intractable DI, acute mental status change, or focal deficits in the days after TSS. Morbidity and death are significant risks in patients with this complication. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/32566415/Symptomatic_Cerebral_Vasospasm_After_Transsphenoidal_Tumor_Resection:_Two_Case_Reports_and_Systematic_Literature_Review L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32566415/ DB - PRIME DP - Unbound Medicine ER -
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