Vascular complications of surgery for craniopharyngioma and hypothalamic glioma.

Vascular complications of surgery for suprasellar tumors include carotid artery laceration, vasospasm, and delayed aneurysmal dilatation of the carotid artery. We report updated follow-up (5-11 years) of 9 patients previously reported with fusiform dilatation of the carotid artery (FDCA) following radical surgical excision of craniopharyngioma, who represent 15.7% of 57 patients operated between 1982 and 1993. None of these patients have experienced hemorrhage or other symptoms referable to the carotid artery abnormality, and none have required treatment. We also report an additional 2 cases of FDCA which were discovered 8 and 11 years after surgery for chiasmatic/hypothalamic astrocytoma. One of these patients experienced headaches and possible hemorrhage, and underwent surgery for the lesion with a poor result. Unless further experience suggests otherwise, it is recommended that asymptomatic patients with this lesion be simply observed, and that surgical exploration for FDCA be reserved for those patients who experience symptoms.