Cerebral Vasospasm as a Delayed Complication Following Glioblastoma Resection

Postoperative cerebral vasospasm is usually triggered by vasoactive metabolic blood products in the subarachnoid space but is rarely reported following resection of intrinsic diffuse lobar neoplasms such as malignant gliomas. This 34-year-old right-handed Caucasian lady underwent an uneventful resection of a right mesial temporal lobe glioblastoma with no postoperative neurological deficits. Eight days after her index surgery, she presented with left-sided hemiparesis and dysarthria and was found to have right M1 narrowing, consistent with cerebral vasospasm. Intra-arterial calcium channel blocker (CCB) administration and induced hypertension were started to treat the cerebral vasospasm and resulted in resolution of most of her neurological deficits. At 2 months postresection, she was noted to be without neurological deficits and able to proceed with appropriate adjuvant therapies for the glioblastoma. Postoperative cerebral vasospasm following resection of a glioblastoma can occur and present in a similar manner and timeframe as post-subarachnoid hemorrhage vasospasm. Prompt recognition of this condition followed by endovascular intervention and systemic treatments to improve cerebral perfusion are essential at reducing the risk of permanent cerebral ischemia and deficits.