Vasospasm following resection of olfactory groove meningiomas via orbitozygomatic craniotomy: illustrative cases.

backgroundOlfactory groove meningiomas (OGMs) are benign anterior cranial fossa tumors that may encase critical neurovascular structures. While vasospasm is a well-established sequela of aneurysmal subarachnoid hemorrhage, its occurrence following meningioma resection remains rare and underrecognized. OBSERVATIONS: The authors present illustrative cases of 2 female patients (ages 70 and 39 years) with large OGMs who underwent resection via orbitozygomatic craniotomy. Both patients developed delayed postoperative vasospasm requiring intra-arterial pharmacological and endovascular intervention. In both cases, imaging revealed vasospasm involving the anterior circulation, including the anterior cerebral arteries and internal carotid arteries. The first patient was managed with intra-arterial verapamil alone, while the second underwent balloon-assisted angioplasty in addition to verapamil administration. Radiological improvement and favorable clinical outcomes were achieved, with 1 patient recovering full vision despite initial blindness. LESSONS: Postoperative vasospasm is an important but often overlooked complication following anterior skull base meningioma resection. Early recognition and aggressive management with intra-arterial therapy can mitigate ischemic complications. Neurosurgeons should maintain high suspicion for vasospasm in the setting of neurological decline after tumor resection near the circle of Willis. https://thejns.org/doi/10.3171/CASE25641.