gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

The use of Nicardipine Prolonged Release Implants (NPRI) in microsurgical clipping after Aneurysmal Subarachnoid Haemorrhage (SAH) – Comparison to endovascular coiling

Meeting Abstract

  • U. Schneider - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • S. Dreher - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • H. Kasuya - Department of Neurosurgery, Tokyo Womens Medical University, Tokyo, Japan
  • P. Vajkoczy - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.05-02

DOI: 10.3205/09dgnc136, URN: urn:nbn:de:0183-09dgnc1366

Veröffentlicht: 20. Mai 2009

© 2009 Schneider et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Nicardipine prolonged release implants (NPRI) have been shown to decrease the incidence of cerebral vasospasm and infarcts significantly in patients after aneurysmal subarachnoid haemorrhage (SAH) following microsurgical clipping. Yet, the comparison to results after endovascular coiling is lacking. This study was conducted to determine the differences in the incidence of vasospasm and cerebral infarctions between those two treatment modalities.

Methods: Within a one-year interval 74 consecutive patients suffering from acute SAH (including all WFNS grades) verified by computed tomography were admitted to our institution. Ten patients did not receive any treatment due to absence of an aneurysm or early decease. 25 patients were treated with endovascular coiling, 36 were treated with microsurgical clipping depending on the decision of an interdisciplinary board, 3 patients were treated otherwise. Of the 36 surgically treated patients, in 27 patients NPRIs were placed into the basal cisterns along the supplying arteries. The incidence of angiographic vasospasm (DSA on day 8±1 after SAH) and cerebral infarctions (CT on day 14±2 after SAH) were documented.

Results: All groups were comparable concerning demographics and severity of SAH. 19 of 64 patients developed angiographic vasospasm. The incidence of vasospasm was 48%, 11% and 44% for patients after endovascular coiling, microsurgical clipping with and without NPRI, respectively. New cerebral infarctions occurred in 28%, 7% and 22% of the according patients.

Conclusions: The use of NPRI during microsurgical clipping proved to be safe and effective. Patients who received intracisternally implanted NPRI during clipping after aneurysmal SAH yielded significantly lower vasospasm and infarction rates when compared to clipping without NPRI and also when compared to endovascular coiling.