Symptomatic vasospasm after resection of a suprasellar pilocytic astrocytoma: Case report and possible pathogenesis

BACKGROUND Cerebral vasospasm from pathology other than subarachnoid hemorr hage is uncommon. A case of severe vasospasm after resection of a suprasell ar pilocytic astrocytoma is reported. METHODS A 45-year-old male presented with headache, left facial numbness, b ilateral visual loss, and ataxia. Evaluation revealed a large suprasellar t umor, which was resected. Pathologic examination showed pilocytic astrocyto ma. The patient developed hemiparesis and aphasia on the fifth postoperativ e day. Vascular spasm was documented on angiography and by transcranial Dop pler. RESULTS Intraarterial papaverine resulted in moderate angiographic improvem ent. Attempts to open middle cerebral artery branches with angioplasty were unsuccessful. The patient subsequently developed a left middle cerebral ar tery infarct. CONCLUSIONS To our knowledge, this is the first description of vasospasm af ter resection of an astrocytoma. Possible mechanisms contributing to this u nusual complication after resection of tumors ape discussed.