gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Continuous local intra-arterial nimodipine-application in severe symptomatic vasospasm following subarachnoid hemorrhage

Meeting Abstract

  • C. Musahl - Neurochirurgische Klinik, Klinikum Stuttgart
  • H. Henkes - Klinik für Neuroradiologie, Klinikum Stuttgart
  • D. Schildheuer - Neurochirurgische Klinik, Klinikum Stuttgart
  • N. Hopf - Neurochirurgische Klinik, Klinikum Stuttgart

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. DocP13-07

DOI: 10.3205/09dgnc393, URN: urn:nbn:de:0183-09dgnc3930

Published: May 20, 2009

© 2009 Musahl et al.
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Outline

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Objective: Symptomatic cerebral vasospasm is a well known complication following subarachnoid hemorrhage (SAH). In a significant number of patients vasospasm causes ischemic stroke despite aggressive non-invasive medical therapy. We present a series of four patients with severe symptomatic vasospasm that were treated by continuous local intra-arterial nimodipine-application (CLINA).

Methods: Between September 2007 and November 2008 four patients (3 female, 1 male) were treated with CLINA. The patients’ age ranged from 39 to 54 with a mean age of 48.7 years. Three patients (2 female, 1 male) suffered from aneurysmal SAH, one patient from postoperative SAH following excision of a sphenoid wing meningioma. Three patients developed focal neurological deficits (2 hemiparesis, 1 hemiparesis and aphasia). The fourth patient showed a massive drop in tissue oxygen pressure (ptiO2) while still sedated. All four patients underwent conventional cerebral angiography within the first two hours after onset of symptoms with placement of a 0.94 mm OD Rebar27 microcatheter into the distal internal carotid artery (ICA) of the symptomatic hemisphere. Initially, 2mg glycerol trinitrate were injected intra-arterially as a bolus followed by a continuous nimodipine infusion of 2ml/h.

Results: Neurological deficits improved dramatically or even resolved completely within the first few hours after the procedure in all three patients with focal neurological deficits, and ptiO2 values returned to normal in the fourth patient. In addition, in all patients a slight reduction of blood flow velocity could be detected by transcranial Doppler sonography. The microcatheter was removed after considerable reduction of vasospasm based on transcranial Doppler sonography, cerebral angiography, ptiO2, and/or stable neurological condition of the patient. The duration of CLINA ranged between 3 and 6 days.

Conclusions: Severe symptomatic cerebral vasospasm is still a frightening condition following SAH but may also occur after scull base surgery. If HHH-therapy fails, continuous local intra-arterial nimodipine-application (CLINA) seems to be an effective and safe treatment option for selected patients with considerably lower risks in comparison with other invasive treatment modalities, such as balloon dilatation.