title: Vasospasm After Craniopharyngioma Surgery: Can We Prevent It?
abstract: BACKGROUND
  Vasospasm after craniopharyngioma surgery, although rare, has been reported. Hypotheses regarding possible causative factors, including major vessel handling during surgery and tumor cyst fluid spillage, do not explain vasospasm occurring in the late postoperative period. We have attempted to consider the probable pathogenic mechanisms of this complication and measures to prevent it.
  
  
  METHODS
  Of 60 patients operated for craniopharyngiomas over a period of 4 years, 6 who had clinical and radiologically demonstrable vasospasm were identified. Each case was analyzed retrospectively, and relevant variables were studied.
  
  
  RESULTS
  Five of the 6 patients developed vasospasm in the second or third week after surgery. Only 2 of these patients had a favorable outcome. There was significant altered fluid balance during this period; however, patients remained misleadingly eunatremic. This most often coincided with the transition period from syndrome of inappropriate antidiuretic hormone to diabetes insipidus (DI) and the period after steroid taper to minimal dose.
  
  
  CONCLUSIONS
  Major vessel handling during radical craniopharyngioma surgery is likely to predispose them to spasm, accentuated by rapid shifts of fluid and electrolytes during different phases of DI. This is further complicated by a relative hypocortisolic state caused by tendency to taper off steroids early. Hypocortisolism masks DI leading to dehydration and possibly vasospasm. Once vasospasm develops, it is not easy to reverse. Radiologic reversal with intra-arterial nimodipine may not translate into a good clinical response. Therefore, prudence lies in its prevention. Close monitoring of fluids and electrolytes with optimal steroid cover is necessary until stabilization of DI to prevent this complication.
authors.affiliation: Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Apinderpreeet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India. Electronic address: drpravin_salunke@yahoo.co.uk.
authors.forename: Pravin
authors.initials: P
authors.lastname: Salunke
authors.affiliation: Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Vasundhara
authors.initials: V
authors.lastname: Rangan
authors.affiliation: Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Chirag K
authors.initials: CK
authors.lastname: Ahuja
authors.affiliation: Department of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhadada
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
keywords: Craniopharyngioma; Diabetes insipidus; Hypocortisolemia; Hyponatremia; Vasospasm