Sci Forschen Open HUB for Scientific Research Journal of Neurology and Neurobiology Open Access Copyright: © 2016 Spallone A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Volume: 3.1 Case Report Lately-Occurring Stroke following Glioma Surgery: Report of a Case and Review of the Literature Spallone A 1, 2 *, Lavorato L 1 and Di Capua M 1 1 Department of Clinical Neurosciences-Section of Neurosurgery, NCL (Neurological Centre of Latium) - Neuromed, Rome, Italy 2 Catholic University “Our Lady of Good Counsel”, Tirana, Albania Received date: 22 Oct 2016; Accepted date: 22 Nov 2016; Published date: 28 Nov 2016. Citation: Spallone A, Lavorato L, Di Capua M (2016) Lately-Occurring Stroke following Glioma Surgery: Report of a Case and Review of the Literature. J Neurol Neurobiol 3(1): doi http://dx.doi. org/10.16966/2379-7150.134 Copyright: © 2016 Spallone A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. * Corresponding author: Spallone A, Department of Clinical Neurosciences-Section of Neurosurgery, NCL-Neurological Centre of Latium, Rome, Italy, Tel: 06763741; E-mail: segreteria1@nclroma.it Introduction Te occurrence of post-operative stroke following surgery for brain glioma is a rare complication as a rule related to intraoperative technical difculties leading to signifcant vessel occlusion [1]. Postoperative stroke has a negative impact on quality of life following surgery and may afect negatively postoperative survival of glioma-bearing patients. Ischemic stroke occurring relatively late following an apparently uncomplicated surgery for cerebral glioma is an extremely rare event: 20 out of 6500 cases (0.03%) in a large cases series from a single Institution reported very recently [2]. We report here a case of a 64-yers-old man who developed a stroke two weeks following an apparently uncomplicated, though technically demanding, gross total removal of a deep temporal glioma. Case Report A 64-years-old right-handed man was admitted in May 2015 with a diagnosis of intracerebral right temporal lesion detected by CT- scan (Computerized Tomography Scan). General examination was unremarkable. Te patient was a long-time smoker under treatment for mild arterial hypertension. No other risk factors for vascular diseases were encountered. Post-contrast MRI (Magnetic Resonance Imaging) completed with MRI angiography demonstrated an irregularly enhancing round temporo-insular lesion which dislocated superiorly to the right the M2-M3 branches of the right middle cerebral artery (MCA) (Figure 1). Te patient underwent an awake gross-total resection of the mass two days afer his admission. Surgery was uneventful although the removal of the deepest portion of the tumor had required careful dissection under high magnifcation from some tightly adherent M3 branches, which were carefully respected. Te patient exhibited a slight motor weakness of the lef extremities which did not prevent him from walking a few hours following surgery and disappeared a few days later. Postoperative CT-scan (Figure 2) showed some contrast enhancement at the deep periphery of the surgical cavity which was interpreted as possible tumor residual, in spite of the intraoperative impression of gross total removal. Post-contrast ISSN 2379-7150 Abstract The occurrence of post-operative stroke following surgery for brain glioma is a rare complication as a rule related to intraoperative technical diffculties leading to signifcant vessel occlusion. Ischemic stroke occurring relatively late following an apparently uncomplicated surgery for cerebral glioma is an extremely rare event. We report here a case of a 64-yers-old man who developed a stroke two weeks following an apparently uncomplicated, though technically demanding, gross total removal of a deep temporal glioma and discuss the possible implications of this, though extremely rare, pathological event. Keywords: Glioma; Surgery; Stroke; Ischemic MRI performed on the following day showed total removal of the lesion (Figure 3). Post-operative steroid therapy was tapered gradually and the patient was discharged on post-operative day 6 th . 15 days later he was readmitted on an emergency basis due to sudden occurrence of a lef hemiparesis. Emergency CT-scan showed only local swelling. MRI demonstrated early ischemia in the right MCA territory and Angio-MRI showed some possible spasm of the supraclinoid ICA (Internal Carotid Artery) with MCA occlusion at its bifurcation (Figure 4). In the following days there was a slight improvement of his dense hemiparesis, and the patient was referred elsewhere for possible radiotherapeutic treatment. While waiting for this he developed a signifcant CSF (Cerebrospinal Fluid) accumulation at the surgical site, which did not respond to local treatment and required implantation of a uni-shunt valve, afer which the fap swelling resolved. He was then admitted to an oncological department for post-operative radio- and chemotherapy, which was initiated but soon thereafer interrupted due to supervening pneumonia. Tis was treated with an initial success, but recurred later and ultimately led to his death, four month following surgery, three month and a half afer the stroke. Te last CT-scan still did not show residual tumor (Figure 5). Te patient underwent surgery of brain glioma resection according to the operating standards. Radiological examinations were subsequently performed with CT scan and MRI (1.5T). A) B) Figure 1: (A,B) Pre-op post contrast MRI (axial seed angio MRI).