title: Reversal of Visual Impairment Associated with Vasospasm After Resection of Sphenoclinoidocavernous Meningioma with Intra-Arterial Verapamil.
abstract: BACKGROUND
  Visual loss can be encountered in the immediate, early, or even delayed postoperative period after resection of skull base meningiomas involving the optic apparatus. Various mechanisms for visual loss can include mechanical injury, vascular insult, optic nerve and chiasm edema, and vasospasm of the blood supply to the visual apparatus.
  
  
  METHODS
  In this article, we describe a patient who developed unilateral visual worsening in the early postoperative period after skull base resection of a sphenoclinoidocavernous meningioma that was compressing the ipsilateral optic nerve. After implementing hyperdynamic therapy and high-dose corticosteroids, catheter angiography showed severe vasospasm of the ipsilateral ophthalmic artery with delayed filling of the choroidal blush. Intra-arterial chemical angioplasty with verapamil was administered that resulted in angiographic improvement and clinical restoration of vision back to preoperative baseline. Vision remained stable in the postoperative course and continued to improve after discharge from the hospital.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of successful reversal of postoperative unilateral visual loss related to vasospasm after resection of a skull base sphenoclinoidocavernous meningioma. This may be a useful strategy to diagnose and treat possible vasospasm-induced visual loss after resection of skull base meningiomas involving the optic apparatus.
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Neurology and Neuroscience, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Neurology and Neuroscience, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Neurology and Neuroscience, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Inder Paul
authors.initials: IP
authors.lastname: Singh
authors.affiliation: Department of Neurology and Neuroscience, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Sciences, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Larry P
authors.initials: LP
authors.lastname: Frohman
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Neurology and Neuroscience, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Radiology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Chirag D
authors.initials: CD
authors.lastname: Gandhi
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA. Electronic address: james.liu.md@rutgers.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy; D008579:Meningioma / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D019291:Skull Base / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology; D014700:Verapamil / Q000627:therapeutic use*; D015354:Vision, Low / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D014665:Vasodilator Agents; D014700:Verapamil
keywords: Endovascular treatment; Ophthalmic artery; Skull base meningioma; Sphenoid wing; Vasospasm; Vision loss