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

Symptomatic cerebral vasospasm in the setting of carmustine wafer placement for glioblastoma: A case presentation and review of literature

“…sCVS occurred immediately after surgery in the case described by Muzii et al and likely follows the course of sCVS secondary to manipulation. [7,11,19,21,28,29] Given the fact that, the peak effect of carmustine wafers occurs around day 5-7 after implantation, [13,14,26] a delayed course of vasospasm as displayed in our case and the case presented by Nakada et al seems more likely to follow the pathogenesis. [22] erefore, the delayed onset of symptoms in future cases of Gliadel placement should raise suspicion of this phenomenon for clinicians.…”

“…[13,14,26] e concentration of BCNU at the site of implantation is 1200 times higher than that achieved with administration of systemic carmustine. [13,14,21,22,26] e exact mechanism of sCVS secondary to BCNU implantation is unclear, though it is likely a combination of local toxicity, inflammatory mediators released in response to foreign body reaction to the polymer, and the vasospastic effects of carmustine. [21,22] High-dose intravenous carmustine (800/m 2 ) has been associated with retinal artery narrowing and obstruction.…”

“…[13,14,21,22,26] e exact mechanism of sCVS secondary to BCNU implantation is unclear, though it is likely a combination of local toxicity, inflammatory mediators released in response to foreign body reaction to the polymer, and the vasospastic effects of carmustine. [21,22] High-dose intravenous carmustine (800/m 2 ) has been associated with retinal artery narrowing and obstruction. [31] Carmustine has also been shown to induce vasospasm in rabbit models through inhibition of glutathione reductase activity, indicating presence of local inflammatory reactions secondary to the foreign wafers.…”

“…of carmustine-impregnated wafer implantation. [21,22] e phenomenon is believed to be secondary to a combination of the vasospastic properties of carmustine, local toxicity, and inflammation. [21,22] In this case report, we present a patient who experienced sCVS attributed to carmustine-impregnated wafer placement after the resection of glioblastoma (GBM).…”

“…[21,22] e phenomenon is believed to be secondary to a combination of the vasospastic properties of carmustine, local toxicity, and inflammation. [21,22] In this case report, we present a patient who experienced sCVS attributed to carmustine-impregnated wafer placement after the resection of glioblastoma (GBM). Given the high morbidity of sCVS, the authors propose high index of clinical suspicion, timing of this phenomenon, recommendations for placement, and early identification by utilizing CT angiography in the setting of postoperative symptoms.…”