Fatal malignant cerebral vasospasm following pediatric craniopharyngioma resection: A case report and literature review

Abstract

Background: Cerebral vasospasm is a rare but devastating complication following intracranial tumor surgery, particularly in pediatric suprasellar lesions such as craniopharyngiomas. Delayed cerebral ischemia secondary to postoperative vasospasm remains insufficiently recognized and may result in fatal neurological injury. Case Description: We report the case of a 5-year-old girl who underwent gross total resection of a cystic suprasellar craniopharyngioma through a subfrontal approach without intraoperative vascular injury. The immediate postoperative course was uneventful. On postoperative day 6, the patient developed sudden refractory status epilepticus associated with rapid neurological deterioration and bilateral fixed mydriasis. Brain computed tomography (CT) revealed extensive left hemispheric ischemia with severe cerebral edema. CT angiography demonstrated marked narrowing of the A1 + M1 segment of the left middle cerebral artery, consistent with malignant cerebral vasospasm. Despite intensive care management, the patient progressed to brain death and subsequently died. Conclusion: Delayed malignant cerebral vasospasm following pediatric craniopharyngioma resection is an unpredictable and potentially fatal complication that may occur even in the absence of intraoperative vascular injury. Prompt recognition of delayed neurological deterioration and early vascular imaging are crucial to improve diagnostic and therapeutic management.