RESUMO
BACKGROUND: Symptomatic cerebral vasospasm following posterior fossa intra-axial tumor resection is a rare phenomenon with only seven cases previously reported in the literature. The condition appears distinct to vasospasm following supratentorial tumor resection and extra-axial tumor resection of the posterior fossa. It shares, however, similarities with vasospasm following aneurysmal subarachnoid hemorrhage. OBSERVATIONS: The authors describe their experience with a 23-year-old female who developed delayed symptomatic vasospasm following resection of a left parapontine cerebellar hemangioblastoma. Tumor resection was complicated by rupture of a fragile arterialized vein, resulting in significant hemorrhage. The patient developed several episodes of focal and variably reversible neurological deficit. These clinical signs corresponded with angiographically confirmed vasospasm, which responded to standard therapies for vasospasm post aneurysmal subarachnoid hemorrhage. LESSONS: This case and literature review highlight that symptomatic vasospasm is a rare, potentially highly morbid complication of posterior fossa intra-axial tumor resection. This phenomenon may be related to significant intraoperative or postoperative hemorrhage. Postoperative radiological findings such as high risk modified Fisher scale hemorrhage could alert clinicians to this condition.
RESUMO
Previous studies have shown that spot signs on imaging modalities such as CT perfusion, delayed phase CTA or post contrast CT imaging reportedly have greater ability to predict haematoma expansion (HE) than the traditional CT angiography spot sign. We performed a systematic review and meta-analysis of the diagnostic accuracy of the spot sign on delayed imaging modalities in predicting haematoma expansion. Pubmed, Excerpta Medica Database, and the Cochrane library were searched on the 11 November 2019. The search strategy utilised the following terms: CT angiography OR post contrast CT OR CT perfusion OR CT AND intracerebral haemorrhage (or synonyms) AND spot sign OR delayed spot sign OR dynamic spot sign. The area under the summary of receiver operating curves for diagnostic accuracy of delayed spot sign in predicting HE was calculated using bivariate random effects meta-analysis. 501 articles were identified, with 10 meeting inclusion criteria. The studies included 711 patients overall, with 272 (38%) demonstrating a spot sign. The presence of a delayed spot sign was associated with HE with a diagnostic odds ratio of 25.4 (12.7-50.9). Pooled sensitivity was 0.81 (0.72-0.88), with a pooled specificity of 0.82 (0.76-0.88). Pooled positive likelihood ratio was 4.30, with a pooled negative likelihood ratio of 0.26. The area under the receiver operating curve (AUC) was 0.88. The delayed spot sign has greater diagnostic accuracy in predicting haematoma expansion than the traditional CT angiography spot sign. Further research could determine the delayed imaging technique that has the greatest diagnostic accuracy.
