Symptomatic intraoperative middle cerebral artery vasospasm after anterior temporal lobectomy for refractory epilepsy: An illustrative case and review of the literature

Abstract

Cerebral vasospasm, defined as the reversible constriction of cerebral arteries, is a deleterious complication, most related to aneurysmal subarachnoid hemorrhage. Although vasospasm can occur in the setting of traumatic subarachnoid hemorrhage, brain tumor resection, ruptured arteriovenous malformation with intraventricular extension, and other central nervous system insults, aneurysmal subarachnoid hemorrhage remains the most common cause. An association between vasospasm and anterior temporal lobectomy has been described in a few case reports. We report the case of a 32-year-old male patient, known to have refractory seizures developed left middle cerebral artery vasospasm after left anterior temporal lobectomy in the direct postoperative period. He underwent cerebral digital subtraction angiography and received intraarterial nicardipine as well as temporary stenting using a stent retriever, with swift restoration of arterial flow in the affected segments and remarkable improvement in his neurological examination. Therefore, symptomatic cerebral vasospasm remains a rare complication after temporal lobectomy, but its consequences can be catastrophic, and knowledge about this condition is fundamental to allow early diagnosis and prompt treatment.