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Delayed cerebral ischemia after meningioma resection: Literature review and illustrative case
C-H Mallereau1, M Ribeiro1, F-D Ardellier2
1Neurosurgery Department, Strasbourg University Hospital, Strasbourg, France.
Background:
Cerebral vasospasm results from arterial vasoconstriction, mainly following aneurysmal subarachnoid hemorrhage, and may cause delayed cerebral ischemia (DCI). DCI rarely occurs after tumor resection. We performed a systematic review of the literature together with a case report of DCI after meningioma resection.
Literature Review:
METHODS: A systematic literature review was performed following the PRISMA statement, searching the PubMed, Medline and Cochrane databases using keywords and MESH terms related to "vasospasm/DCI and meningioma resection".
Results:
In the studies retrieved in the literature, 5 cases of DCI after meningioma surgery were identified. The average age of patients was 52 years. The average onset time of DCI was 9.7 days. Clinical presentation was highly variable: hemiparesis (60%), confusion (60%) and/or aphasia (40%). Meningioma location was most frequently sphenoidal (60%). Most patients had vasospasm in multiple cerebral vessels, involving only the anterior circulation. Various management strategies were used: endovascular treatment (33.3%), antiplatelet therapy (50%) and/or nimodipine (40%). In terms of outcome, there were no deaths, but most patients had variable neurological sequelae (80%): aphasia, visual impairment, hemiparesis.
Conclusion:
The systematic literature review and the present case of DCI following resection of an olfactory meningioma suggested that the main etiologic factors causing this rare pathology are: 1) intraoperative subarachnoid hemorrhagic contamination; 2) microvascular manipulation; 3) and possible dysregulation of hypothalamic function.
Insights
Delayed cerebral ischemia (DCI) is rare after meningioma resection. Potential causes include intraoperative bleeding, microvascular manipulation, and hypothalamic dysfunction, leading to varied neurological deficits.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurology
Background:
- Cerebral vasospasm, a cause of delayed cerebral ischemia (DCI), typically follows subarachnoid hemorrhage.
- DCI is an uncommon complication after brain tumor resection.
- This study reviews DCI following meningioma surgery, including a case report.
Observation:
- A systematic review identified 5 cases of DCI post-meningioma resection.
- Patients averaged 52 years old, with DCI onset around 9.7 days post-op.
- Common symptoms included hemiparesis, confusion, and aphasia, often linked to vasospasm in anterior circulation vessels.
Findings:
- Sphenoidal meningiomas were most frequent (60%).
- Management involved endovascular treatment (33.3%), antiplatelet therapy (50%), and nimodipine (40%).
- While no deaths occurred, 80% experienced neurological sequelae like aphasia or hemiparesis.
Implications:
- Etiologic factors for DCI post-meningioma resection include intraoperative hemorrhage, microvascular manipulation, and hypothalamic dysregulation.
- Understanding these factors can guide preventative strategies and management.
- Further research is needed to elucidate the mechanisms and optimize outcomes for this rare complication.
