Predictors of Acute Vertebrobasilar Vasospasm following Tumor Resection in the Foramen Magnum Region.
OBJECTIVE
Cerebral vasospasm can occur after skull base tumor removal. Few studies concentrated on the posterior circulation vasospasm after tumor resection in the posterior fossa. We aimed to identify the risk factors associated with postoperative vertebrobasilar vasospasm after tumor resection in the foramen magnum.


METHODS
We retrospectively reviewed the data of 62 patients with tumors in the foramen magnum at our institution from January 2010 to January 2015. The demographic data, tumor features, surgical characteristics were collected. Vertebrobasilar vasospasm was evaluated by bedside transcranial Doppler before surgery and on postoperative day 1, 3, 7. Univariate and multivariate analyses were performed to determine the predictors of postoperative vasospasm in the posterior circulation.


RESULTS
Vertebrobasilar vasospasm was detected in 28 (53.8%) of the 62 patients at a mean time of 3.5 days after surgery. There were 5 (8%) patients with severe vasospasm according to the grading criteria. Age, tumor type, tumor size, vertebral artery encasement, and surgical time were significantly related to vasospasm in the univariate analysis. Further multivariate analysis demonstrated that only age and vertebral artery encasement were independent risk factors predicting the occurrence of postoperative vertebrobasilar vasospasm.


CONCLUSIONS
The incidence of acute vertebrobasilar vasospasm is not uncommon after foramen magnum tumor resection. Age and vertebral artery encasement are significantly correlated with postoperative vasospasm. Close monitoring of vasospasm should be given to patients with younger age and the presence of vertebral artery encasement on the preoperative imaging to facilitate early diagnosis and intervention.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Chuanyuan
C
Tao
Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China.
Jiajing
J
Wang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Yuekang
Y
Zhang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Shirong
S
Qi
Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China.
Fan
F
Liu
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Chao
C
You
Neurosurg Rev. 2016 Jul;39(3):429-36
26940102
Crit Care Med. 2015 Mar;43(3):674-85
25479116
J Stroke Cerebrovasc Dis. 2013 Jan;22(1):22-7
21719308
Stroke. 2008 Apr;39(4):1197-204
18323502
Neurosurgery. 2006 Aug;59(2):360-6; discussion 360-6
16883176
Acta Neurochir (Wien). 1995;132(1-3):53-8
7754859
Drugs Aging. 1995 Oct;7(4):278-91
8535055
Neurosurgery. 2012 Sep;71(1 Suppl Operative):173-80; discussion 180-1
22249952
Neurocrit Care. 2013 Feb;18(1):84-8
22911499
J Neurointerv Surg. 2016 Jun;8(e1):e17-9
24705735
World Neurosurg. 2015 Dec;84(6):1686-90
26187110
Surg Neurol. 1999 Dec;52(6):577-83; discussion 583-4
10660023
Neurosurg Rev. 2012 Jul;35(3):359-67; discussion 367-8
22430127
J Neurointerv Surg. 2013 Sep 1;5(5):413-8
22914745
Neurosurg Rev. 2016 Oct;39(4):535-44
26662045
Neurosurg Clin N Am. 2009 Jul;20(3):265-78
19778699
World Neurosurg. 2014 Dec;82(6):1216-23
25108294
Stroke. 2002 Jan;33(1):72-7
11779892
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1453-64
25957908
Neuroradiol J. 2014 Apr;27(2):186-90
24750707
Neurosurgery. 2011 Oct;69(4):876-83; discussion 883
21558976
Neuropsychiatr Dis Treat. 2015 Feb 05;11:317-20
25709454
Stroke. 2001 Sep;32(9):2005-11
11546889
J Res Med Sci. 2010 May;15(3):133-9
21526072
Pituitary. 2013 Jun;16(2):260-9
22843020
Surg Neurol. 1999 May;51(5):521-6; discussion 526-7
10321883
Ital J Neurol Sci. 1996 Aug;17 (4):291-4
8915761
Catheter Cardiovasc Interv. 2006 Jul;68(1):104-11
16763991
Neurosurg Focus. 2015 Apr;38(4):E14
25828490
J Neurol Sci. 2010 Dec 15;299(1-2):112-5
20884015
World Neurosurg. 2014 Feb;81(2):283-4
23523680
Neurosurg Focus. 2013 Dec;35(6):E12
24289120
J Neurosurg. 2016 May;124(5):1257-64
26495942
Neurocrit Care. 2011 Feb;14 (1):86-90
21042882