Reversible cerebral vasoconstriction syndrome as a rare postoperative complication after resection of a rosette-forming glioneuronal tumor: a case report and literature review.

Abstract

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is an uncommon postoperative complication, rarely reported after posterior fossa tumor resections. Rosette-forming glioneuronal tumor (RGNT) is an infrequent, low-grade neoplasm of the central nervous system. To our knowledge, no prior cases of RCVS following RGNT resection have been documented.

Case summary: We report a male patient in his 20s who underwent suboccipital craniotomy for resection of a cerebellar RGNT. Three weeks postoperatively, the patient presented with acute right hemiparesis and aphasia. Brain MRI demonstrated a left hemisphere watershed ischemic lesion. Magnetic resonance angiography revealed narrowing and "beading" of major intracranial arteries bilaterally, consistent with RCVS. Management included therapeutic anticoagulation, dual antiplatelet therapy, and intravenous hydration. The patient achieved complete neurological recovery.

Clinical discussion: RCVS is characterized by transient, reversible multifocal cerebral arterial vasoconstriction and is associated with vasoactive triggers and surgical stress. Postoperative RCVS is rare after posterior fossa surgery, and differentiation from primary angiitis of the CNS and thromboembolic stroke is essential. Proposed mechanisms include endothelial dysfunction, surgical manipulation, and hemodynamic changes.

Conclusion: RCVS can manifest as a delayed complication after posterior fossa tumor resection; Prompt diagnosis and supportive management are essential for recovery.