Delayed cerebral ischemia after meningioma resection: Literature review and illustrative case.

ABSTRACT

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.