Background: Delayed Cerebral vasospasm can occur following surgical resection of Craniopharyngioma in sellar and suprasellar subarachnoid cisterns. Early cerebral vasospasm following Craniopharyngioma surgery without subarachnoid hemorrhage is very rare; the pathophysiology is poorly understood and can cause significant post operative morbidity and mortality. Case description: A 3 years old female presented with recurrent suprasellar, underwent re-exploration and excision of the tumor. She had Diabetes Insipidus post operatively, managed with Tab Minirin and subsequently had neurological deterioration with dense left sided hemiplegia. CT brain showed hypodensity in Right fronto temporo parietal region with mass effect and midline shift, suggestive of cerebral infarction, underwent Right fronto temporo parietal decompressive cranicetomy. She improved clinically and neurologically. On two months followup her muscle power improved to 4/5 in both left upper and lower limb, underwent cranioplasty. Another case, a 37 years old male presented with blurring of vision, MRI brain showed sellar suprasellar Craniopharyngioma compressing the optic chiasma. Patient underwent near-total excision, post operatively he had diabetes insipidus, generalized tonic-clonic seizure and dense hemiplegia on right side, MRI brain showed infarct in Left Ganglio capsular region and in the left middle cerebral artery territory and subsequent MRI showed increase in the size of infarct with mass effect and midline shift, an emergency decompressive Crainectomy was performed. During intra-op after durotomy brain was bulging and non-pulsatile. Neurological status did not improved inspite of the surgery and developed severe brain stem dysfunction. Conclusion: Early cerebral vasospasm and cerebral infarct following Craniopharyngioma surgery is very rare. Early diagnosis, aggressive management of Diabetes Insipidus and vasospasm, avoiding spillage of the cystic components of Craniopharyngioma and minimal handling of tumor part close to the hypothalamus as well as leaving behind the capsule close to the hypothalamus during Craniopharyngioma surgery plays an important role in reducing morbidity and mortality.

Keywords: Craniopharyngioma; Early vasospasm; Cerebral infarct; Diabetes Insipidus.