2025 Poster Presentations
P304: LOCAL PAPAVERINE AS A NOVEL ADJUNCT FOR DELAYED VISION LOSS AFTER TUBERCULUM SELLAE MENINGIOMA RESECTION
Mélyssa Fortin, MD; Sylvie Nadeau, MD, FRCSC; Martin Côté, MD, FRCSC; Pierre-Olivier Champagne, MD, PhD, FRCSC; Laval University Medical Center
Context: Tuberculum sellae meningiomas (TSM) are in close anatomic proximity to the optic nerves and frequently compress them as they grow. Patients often present with decreased visual acuity and visual field defects, necessitating surgical intervention. A rare but severe complication following TSM surgery is delayed vision loss after an uncomplicated immediate postoperative period.
The exact mechanism of this complication remains unknown, but ischemic injury is hypothesized to be the primary pathological process. Arterial vasospasm, venous congestion, and reperfusion injury are thought to be major contributors to this condition.
Current therapeutic options are limited, with no proven efficacy. This lack of established treatments underscores the need for innovative approaches to manage this challenging complication.
Methods: We present our experience with the use of local papaverine in two cases of delayed vision loss following endoscopic endonasal removal of TSM.
Results: The patients experienced delayed vision loss at 12 and 16 hours postoperatively. Both underwent surgical field re-exploration on their first postoperative day and received intraoperative local papaverine deposition on the optic nerve. Following local papaverine administration, both patients demonstrated immediate postoperative improvement. They also underwent hyperdynamic therapy, chemical angioplasty with verapamil, and corticosteroid taper.
Conclusion: Vasospasm is suspected to be a major contributor to delayed vision loss. In both patients we observed improved visual function after local antispasmodic (papaverine) therapy as part of a multimodal treatment. The inflammatory cascade, venous congestion, and surgical site edema likely contributed to the delayed presentation of this complication.
We report our experience with local papaverine irrigation as an adjunctive and potentially effective treatment for this condition. This novel treatment option reinforces the current understanding of the complication and introduces a new therapeutic alternative.