Symptomatic cerebral vasospasm after glioblastoma resection and carmustine wafers implantation. A case report

Abstract

Local chemotherapy with carmustine-impregnated wafers showed safe and effective in the treatment of malignant glioma, with infrequent, though sometime serious, adverse effects.We report a rare case of cerebral vasospasm following glioblastoma removal with carmustine wafers implantation in a 57-years-old man. After surgery, the patient awoke with aphasia, due to vasospasm of the left middle cerebral artery. Intra-arterial infusion of nimodipine was performed, with rapid vasospasm resolution and quick recovery.Cerebral vasospasm is an extremely rare adverse effect after carmustine wafers implantation in glioma surgery, with only one case reported. In our case, intra-arterial nimodipine was rapidly effective. Although rare, such a potentially disastrous complication should be considered when a new neurological deficit unexpectedly occurs after carmustine wafers implantation, and vascular investigation should be undertaken. Keywords: Cerebral vasospasm, Glioblastoma, Carmustine wafer