Neurological deficit due to vasospasm after brain tumour resection: A single centre retrospective cohort

Abstract

Background and objectives: Neurological deficit secondary to cerebral vasospasm following tumour resection is a rare yet significant complication that can lead to considerable morbidity and mortality. Pathophysiological mechanisms underlying postoperative vasospasm are complex and multifactorial It is an underdiagnosed entity, with severe consequences. The main objective of this study is to describe the characteristics of patients with vasospasm after tumour resection in a referral centre.

Methods: We performed a retrospective cohort study of consecutive patients who presented post-surgical vasospasm between January 2017 and May 2024 at single institution. The demographic data, tumour features, surgical characteristics, vasospasm diagnosis and management were collected.

Results: twenty-two patients were enrolled, median age was 41 years, and 41 % were female. The location most frequent of lesions was in the sellar/suprasellar space (73 %), and pituitary tumours were the most common pathology. The average time to develop vasospasm was 3 days and mostly was diagnosed using transcranial Doppler (86 %). Almost all patients had the anterior circulation affected (91 %). All patients had pharmacological and supportive treatment, and more than half needed nimodipine. Incomplete recovery after vasospasm was reported in 13 patients (59 %), and 3 patients (14 %) died. No association was seen between outcome and the probable causative factors.

Conclusions: Cerebral vasospasm due to tumour resection is a rare but challenging complication with remarkably high morbidity and mortality in reported cases. A high index of suspicion is required for early diagnosis and prompt management. It should be considered in post-surgical patients with neurological impairment without obvious cause.