gms | German Medical Science

Objective: Intra-arterial spasmolysis with nimodipine in severe vasospasm induced by subarachnoid hemorrhage (SAH), controlled with enhanced neuromonitoring is an intriguing method successfully used in adults. The use in children however, due to the scarcity of aneurysmatic SAH in this age group, is not documented in the literature. We report the cases of two female children, 9 and 15 years of age with WFNS V aneurysmatic SAH treated at our hospital with long-term (6 and 7days) intra-arterial nimodipine infusion and the key role of enhanced neuromonitoring to sufficiently manage the therapy.

Method: Enhanced neuromonitoring is implemented at the earliest convenience if the patient either has to stay intubated or neurological assessment due to the deterioration caused by vasospasm makes an intubation and spasmolysis necessary. Conventional double-H therapy is maintained at all times. If trans-cranial Doppler sonography (TCD) and the enhanced neuromonitoring show a severe vasospasm that cannot be controlled by means of conventional double-H therapy, an angiography is performed and micro catheters are placed proximal to the vasospasm, usually in the carotid or the vertebral artery. The catheters are removed if neuromonitoring and TCD readings remain constant without showing signs of vasospasm after the intra-arterial nimodipine infusion is stopped for 12 hours.

Results: Both patients could be treated successfully with this spasmolytic therapy, in a post-interventional CAT-Scan no infarctions were visible related to the vasospasm. Both girls were discharged to rehab with GOS 3 but are continuously improving on their GOS.

Conclusions: Long-term intra-arterial nimodipine infusion, controlled by enhanced neuromonitoring is a sound, yet very intricate method to treat severe vasospasm in adults. Having no documented literature, our results show, that however rare, children with severe aneurysmatic SAH can be treated accordingly.