Background: Symptomatic cerebral vasospasm following posterior fossa extraaxial tumor resection is a rare phenomenon, with only 13 cases previously reported in the literature. The condition appears similar to vasospasm following supratentorial tumor resection, intraaxial posterior fossa tumor resection, and aneurysmal subarachnoid hemorrhage (aSAH). The majority of patients were not evaluated for vasospasm prior to symptom onset, leading to a delay in diagnosis.
Observations: The authors present their experience in a 55-year-old female who developed delayed cerebral vasospasm after excision of a left sided cerebellopontine angle Meningioma.. Routine postoperative brain computed tomography showed evidence of subarachnoid hemorrhage in the basal cisterns. She developed frontal lobe signs on 7th post-operative day. Angiography confirmed bilateral frontal diffuse cerebral vasospasm. The patient responded to standard hyperdynamic therapy used for vasospasm secondary to aSAH.
Conclusion: Symptomatic distant cerebral vasospasm after posterior fossa extraaxial tumor excision is a rare but challenging complication with a very high morbidity rate in our reported case. A high index of suspicion is required for early diagnosis and prompt management even if there is no direct encasement of vasculature for a favorable outcome. This is the first documented case where excision of extra-axial meningioma was done in posterior fossa and vasospasm occurred in anterior fossa signifying the distal nature of vasospasm.
Keywords
Cerebral Vasospasm; Vestibular Schwannoma; Posterior Fossa; Extraaxial Tumor; complication Patient Informed
Consent: Patient’s informed consent was obtained in this study