Vasospasm after Craniopharyngioma surgery: Can we prevent it?

Vasospasm after Craniopharyngioma surgery: Can we prevent it?

World Neurosurg. 2017 Feb 08;:

Authors: Singh A, Salunke P, Rangan V, Ahuja CK, Bhadada S

Abstract
BACKGROUND: Vasospasm following craniopharyngioma surgery, though rare, has been reported. Hypotheses regarding possible causative factors including major vessel handling during surgery and tumour cyst fluid spillage do not explain vasospasm occurring in the late post operative period. We have attempted to look into the probable pathogenic mechanisms of this complication and measures to prevent it.
MATERIALS AND METHOD: Of 60 patients operated for Craniopharyngiomas over a period of 4 years, 6 who had clinical and radiologically demonstrable vasospasm were identified. Each case was analysed retrospectively and relevant variables were studied.
RESULTS: 5 of the 6 patients developed vasospasm in the second /third week following surgery. Only 2 of these patients had a favourable outcome. There was significant altered fluid balance during this period although patients remained misleadingly eunatremic. This most often coincided with the transition period from SIADHto DI and the period after steroid taper to minimal dose.
CONCLUSION: Radical craniopharyngioma surgery is likely to predispose major cerebral vessels to spasm, accentuated by rapid shifts of fluid and electrolytes during different phases of DI. This is further complicated by a relative hypocortisolic state due to tendency to taper off steroids early. Hypocortisolism masks DI leading to dehydration and possibly vasospasm. Once vasospasm develops, it is not easy to reverse. Radiological reversal with intra-arterial nimodipine may not translate into a good clinical response. Therefore prudence lies in its prevention.Close monitoring of fluids and electrolytes with optimal steroid cover is necessary until stabilisation of DI in order to prevent this complication.

PMID: 28189861 [PubMed - as supplied by publisher]

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