Summary
Vasospasm after resection of skull base tumors is a rare complication that often produces serious ischemic sequelae. In four of the authors' recent cases, vasospasm complicated the patient's post-operative course. A review of the literature produced a number of cases that can help determine possible causes of vasospasm after tumor resection, ways to prevent it, and methods to evaluate it when it occurs. The cause appears to be multifactorial and the surgical approach may contribute to the pathogenesis of vasospasm. Physicians must have a high degree of suspicion to detect vasospasm at an early stage of skull base surgery. Cerebral blood flow measurement and transcranial Doppler are useful monitoring tools.
Similar content being viewed by others
References
Aaslid R, Huber P, Nomes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60: 37–41
Al-Mefty O, Smith RR (1988) Surgery of tumors invading the cavernous sinus. Surg Neurol 30: 370–381
Armstrong FS, Hayes GJ (1961) Segmental cerebral arterial construction associated with pheochromocytoma. Report of a case with arteriograms. J Neurosurg 18: 843–846
Barrow DL, Tindall GT (1990) Loss of vision after transsphenoidal surgery. Neurosurgery 27: 60–68
Boullin DJ, Tagari P, Du Boulay G, Aitken V, Hughes JT (1983) The role of haemoglobin in the etiology of cerebral vasospasm. An in vivo study of baboons. J Neurosurg 59: 231–236
Camp PE, Paxton HD, Buchan GC, Gahbauer H (1980) Vasospasm after trans-sphenoidal hypophysectomy. Neurosurgery 7: 382–386
De Almeida GM, Bianco E, Souza AS (1985) Vasospasm after acoustic neuroma removal. Surg Neurol 23: 38–40
Duff TA, Feilbach JA, Yusuf Q, Scott G (1988) Bilirubin and the induction of intracranial arterial spasm. J Neurosurg 69: 593–598
Echlin FA (1965) Spasm of basilar and vertebral arteries caused by experimental subarachnoid haemorrhage. J Neurosurg 23: 1–11
Ford K, Drayer B, Osborne D, Dubois P (1981) Transient cerebral ischemia as a manifestation of raptured intracranial dermoid cyst. J Comput Asisst Tomogr 5: 895–897
Friedman P, Gass HH, Magidson M (1983) Vasospasm with an unruptured and unoperated aneurysm. Surg Neurol 19: 21–25
Hyde-Rowan MD, Roessmann U, Brodkey JS (1983) Vasospasm following transsphenoidal tumor removal associated with the arterial changes of oral contraception. Surg Neurol 20: 120–124
Kassell NF, Sasaki T, Colohan ART, Nazar G (1985) Cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Stroke 16: 562–572
Krayenbühl H (1960) Beitrag zur Frage des cerebralen angiopastischen Insultes. Schweiz Med Wochenschr 90: 961–965
LeRoux PD, Haglund MM, Mayberg MR, Winn HR (1991) Symptomatic cerebral vasospasm following tumor resection. Report of two cases. Surg Neurol 36: 25–31
Lyons EL, Leeds NE (1967) The angiographic demonstration of arterial vascular disease in purulent meningitis. Report of a case. Radiology 88: 935–938
Mawk JR, Ausman JI, Erickson DL, Maxwell RE (1979) Vasospasm following transcranial removal of large pituitary adenomas. Report of three cases. J Neurosurg 50: 229–232
Mawk JR (1983) Vasospasm after pituitary surgery (letter). J Neurosurg 58: 972
Miller JD, Gudeman SK (1980) Cerebral vasospasm after head injury. In: Wilkins RH (ed) Cerebral arterial spasm. Proceedings of the Second International Workshop, Amsterdam, The Netherlands, 1979. Williams and Wilkins, Baltimore, pp 476–479
Nosoko M, Weir BKA, Lunt A, Grace M, Allen P, Mielke B (1987) Effect of clot removal at 24 hours on chronic vasospasm after SAH in the primate model. J Neurosurg 66: 416–422
Ono M, Misumi S, Nukui H, Kawafuchi J (1981) Vasospasm following removal of a large pituitary adenoma by the subfrontal approach. Report of a case and review of the literature. Neurol Med Chir (Tokyo) 21: 609–614
Origitano TC, Al-Mefty O, Leonetti JP, Izquierdo R (1992) En bloc resection of an ethmoid carcinoma involving the orbit and medial wall of the cavernous sinus. Neurosurgery 31: 1126–1131
Origitano TC, Wascher TM, Reichman OH, Anderson DE (1990) Sustained increased cerebral blood flow with prophylactic hypertensive hypervolemic haemodilution (“Triple-H” therapy) after subarachnoid haemorrhage. Neurosurgery 27: 729–740
Pasqualin A, Vivenza C, Rosta L, Licata C, Cavazzani P, Da Pian R (1984) Cerebral vasospasm after head injury. Neurosurgery 15: 855–858
Peerless SJ (1980) Postoperative cerebral vasospasm without subarachnoid haemorrhage. In: Wilkins RH (ed) Cerebral arterial spasm. Proceedings of the Second International Workshop, Amsterdam, The Netherlands, 1979. Williams and Wilkins, Baltimore, pp 496–498
Sekhar LN, Wechsler LR, Yonas H, Luyckx K, Obrist W (1988) Value of transcranial Doppler examination in the diagnosis of cerebral vasospasm after subarachnoid haemorrhage. Neurosurgery 22: 813–821
Smith RA, Collier HF, Underwood FO (1973) Cerebral vasospasm following myelography. Surg Neurol 1: 87–90
Symon L (1967) An experimental study of traumatic cerebral vascular spasm. J Neurol Neurosurg Psychiatry 30: 497–505
Takao A, Wakuta Y, Kameda H, Tsunami M, Satoh K, Ueda H, Mitani T (1979) A case complicated with severe vasospasm after total removal of a pituitary tumor. Rinshoshinkei 19: 772
Tsunoda M, Ohwada T, Kuramae H, Takagi H, Nakamura N, Miyasaka Y (1972) Two cases of cerebral angiospasm after removal of pituitary tumor. Discussion of clinical course and pathogenesis. In: Proceedings of the 5th symposium of special problems in neurosurgery. Neuron Co, Tokyo, pp 7–17
Wilkins RH (1975) Hypothalamic dysfunction and intracranial arterial spasm. Surg Neurol 4: 472–480
Wilson JF, Feild JR (1974) The production of intracranial vascular spasm by hypothalamic extract. J Neurosurg 40: 473–479
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aoki, N., Origitano, T.C. & Al-Mefty, O. Vasospasm after resection of skull base tumors. Acta neurochir 132, 53–58 (1995). https://doi.org/10.1007/BF01404848
Issue Date:
DOI: https://doi.org/10.1007/BF01404848