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

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.