gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Pharmacokinetics of prophylactic intravenous nimodipine treatment in skull base surgery

Meeting Abstract

  • C. Scheller - Klinik für Neurochirurgie, Universitätsklinikum Halle-Wittenberg, Halle/Saale
  • S. Simmermacher - Klinik für Neurochirurgie, Universitätsklinikum Halle-Wittenberg, Halle/Saale
  • J. Rachinger - Klinik für Neurochirurgie, Universitätsklinikum Halle-Wittenberg, Halle/Saale
  • J. Prell - Klinik für Neurochirurgie, Universitätsklinikum Halle-Wittenberg, Halle/Saale
  • C. Strauss - Klinik für Neurochirurgie, Universitätsklinikum Halle-Wittenberg, Halle/Saale

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.06.03

DOI: 10.3205/11dgnc136, URN: urn:nbn:de:0183-11dgnc1362

Published: April 28, 2011

© 2011 Scheller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Nimodipine is a dihydropyridine calcium antagonist which is primarily used in subarachnoid hemorrhage (SAH). Recently published animal experiments and clinical trials revealed a beneficial effect of nimodipine treatment on long-term outcome of cranial nerve functions following vestibular schwannoma (VS) surgery. A pilot study indicates a superiority of preoperative prophylactic treatment as compared to an intraoperative start or no treatment at all. This study investigates the unknown pharmacokinetics of prophylactically administered nimodipine in patients with an intact blood-brain barrier.

Methods: Samples were taken from 27 patients with skull base lesions in whom surgery was performed in 2009. The series included VS (n=18), skull base meningeomas (n=7), one ependymoma and one epidermoid. Prophylactic intravenous nimodipine infusion was started 10-15 hours before surgery the day before surgery with a dose of 1 mg/h; at 2h, the dose was increased to 2 mg/h under close monitoring of blood pressure. Intraoperative nimodipine levels in serum (intra- and postoperative) and CSF (intraoperative) were determined by high performance liquid chromatography (HPLC) with ultraviolet (UV) detection. The level of nimodipine in the tissue samples (tumor, cranial nerves and dura mater) was determined using HPLC coupled with a tandem mass spectrometer.

Results: In general, there were wide interindividual differences in the nimodipine levels. Mean values for Nimodipine were 46,9 ng/ml (SD; 6,4; min. 4,12 und max. 92,7 ng/ml) for intraoperative serum, 73,2 ng/ml (SD: 16,7; min. 6,6 und max. 253 ng/ml) for postoperative serum and 8,3 ng/ml (SD: 1,5; min. 0,96 und max. 29,7 ng/ml) for intraoperative cerebrospinal fluid (CSF). The correlation of intra- and postoperative serum nimodipine and of intraoperative serum and CSF nimodipine concentrations were statistically significant. Furthermore the correlation between intraoperative serum values and nimodipine concentrations of the tissue samples of collected vestibular nerves (n=8) was very likely (Pearson: 0,711).

Conclusions: Continously administered intravenous nimodipine treatment with a standard dosage of 1–2 mg/h produces serum levels with considerably interindividual variability. Further studies are necessary in order to analyse whether controls of nimodipine serum levels are useful for optimizing nimodipine medication in SAH and in skull base surgery. The serum nimodipine level is a useful marker for CSF and intracranial tissue concentrations of nimodipine.