Cerebral Vasospasm after Posterior Fossa Tumor Surgery: A Case Report and Literature Review

Introduction: This report presents an unusual case of symptomatic vasospasm following resection of posterior fossa tumor in a 9-year-old female patient. To the best of our knowledge, only 6 pediatric cases of vasospasms as a complication of brain tumor surgery have been reported in the literature previously. Case Presentation: After an uneventful 12 days postoperatively, the patient suddenly presented with acute neurological deterioration on the 13th day and MR angiography showed bilateral narrowing of the supraclinoid segments of the internal carotid artery and the proximal parts of the A1 and M1 segments. Hypervolemia and vasospasm treatments were administered, and the patient exhibited no neurological deficit at the time of discharge, confirmed via normal MRI. Conclusion: Early diagnosis and intervention in case of suspected symptomatic cerebral vasospasm after pediatric posterior fossa tumor surgery are essential in order to achieve favorable outcomes.

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Pediatric takotsubo syndrome caused by hydrocephalus after posterior fossa tumor surgery

Child s Nervous System ◽

10.1007/s00381-021-05090-2 ◽

2021 ◽

Author(s):

Junji Koyama ◽

Nobuyuki Akutsu ◽

Atsufumi Kawamura

Keyword(s):

Posterior Fossa ◽

Posterior Fossa Tumor ◽

Tumor Surgery ◽

Takotsubo Syndrome

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Fronto-cerebellar fiber tractography in pediatric patients following posterior fossa tumor surgery

Child s Nervous System ◽

10.1007/s00381-013-2070-3 ◽

2013 ◽

Vol 29 (5) ◽

pp. 715-716

Author(s):

Thora Gudrunardottir ◽

Astrid Sehested ◽

Marianne Juhler ◽

Kjeld Schmiegelow

Keyword(s):

Posterior Fossa ◽

Pediatric Patients ◽

Posterior Fossa Tumor ◽

Tumor Surgery ◽

Fiber Tractography

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Intraoperative neurophysiology in posterior fossa tumor surgery in children

Child s Nervous System ◽

10.1007/s00381-015-2893-1 ◽

2015 ◽

Vol 31 (10) ◽

pp. 1791-1806 ◽

Cited By ~ 6

Author(s):

Francesco Sala ◽

Angela Coppola ◽

Vincenzo Tramontano

Keyword(s):

Posterior Fossa ◽

Posterior Fossa Tumor ◽

Tumor Surgery ◽

Intraoperative Neurophysiology

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Frequency and treatment of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients

Acta Neurochirurgica ◽

10.1007/s00701-018-3496-x ◽

2018 ◽

Vol 160 (5) ◽

pp. 1063-1071 ◽

Cited By ~ 7

Author(s):

Sascha Marx ◽

Maresa Reinfelder ◽

Marc Matthes ◽

Henry W. S. Schroeder ◽

Joerg Baldauf

Keyword(s):

Posterior Fossa ◽

Adult Patients ◽

Posterior Fossa Tumor ◽

Tumor Surgery

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Factors Predicting the Need for Cerebrospinal Fluid Diversion following Posterior Fossa Tumor Surgery in Children

Pediatric Neurosurgery ◽

10.1159/000343009 ◽

2012 ◽

Vol 48 (2) ◽

pp. 93-101 ◽

Cited By ~ 22

Author(s):

C.V. Gopalakrishnan ◽

Amit Dhakoji ◽

Girish Menon ◽

Suresh Nair

Keyword(s):

Cerebrospinal Fluid ◽

Posterior Fossa ◽

Posterior Fossa Tumor ◽

Tumor Surgery ◽

Cerebrospinal Fluid Diversion

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Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1608786 ◽

2017 ◽

Vol 79 (02) ◽

pp. 123-129 ◽

Cited By ~ 4

Author(s):

Ahmed El Damaty ◽

Jotham Manwaring ◽

Ehab El Refaee ◽

Steffen Fleck ◽

Michael Fritsch ◽

...

Keyword(s):

Posterior Fossa ◽

Obstructive Hydrocephalus ◽

External Ventricular Drain ◽

Clinical Signs ◽

Adult Patients ◽

Posterior Fossa Tumor ◽

Third Ventriculostomy ◽

Tumor Surgery ◽

Posterior Fossa Tumors ◽

Asymptomatic Patients

Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF) diversion procedures. The necessity and feasibility of an ETV in these situations has not yet been proven in adult patients. Methods We retrospectively reviewed our prospectively maintained database for ETVs before surgery of posterior fossa tumors in adults. The primary focus of data analyses was the question of whether the ETV was suitable to treat the acute situation of hydrocephalus without an increased rate of complications due to the special anatomical situation with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures were necessary. Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and all of them improved in their clinical course after ETV. Seven patients (17.5%) did not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic or palliative intent in six patients and one patient, respectively. No complications were observed due to ETV itself. No permanent shunting procedure was necessary in a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV, external ventricular drain) were performed in five patients (12.5%). Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa tumor surgery in adult patients. If patients had symptomatic hydrocephalus before tumor surgery, an ETV can be performed, followed by early elective tumor surgery. A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery should be performed in these patients.

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