gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Therapy of refractory cerebral vasospasm with continuous selective intraarterial nimodipine application in aneurysmal subarachnoid hemorrhage

Meeting Abstract

  • Julia Oberhoffer - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg, Deutschland
  • Thomas Kapapa - Abteilung für Neurochirurgie, Universität Ulm, Deutschland
  • Annegret Gardill - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg, Deutschland
  • Bernd Schmitz - Abteilung für Neuroradiologie, Universität Ulm, Deutschland
  • Melanie Schick - Abteilung für Neuroradiologie, Universität Ulm, Deutschland
  • Christian R. Wirtz - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg, Deutschland
  • Ralph W. König - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.07.09

DOI: 10.3205/12dgnc065, URN: urn:nbn:de:0183-12dgnc0655

Published: June 4, 2012

© 2012 Oberhoffer et al.
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Outline

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Objective: Cerebral vasospasm is still a major cause of morbidity and mortality in aneurysmal SAH. Various endovascular therapies have been reported as rescue therapy for refractory cerebral vasospasm. We report our experience with continuous intraarterial nimodipine application.

Methods: Between 02/2010 and 10/2011 11 patients were treated with continuous i.a.-nimodipine. Patient selection: Refractory vasospasm based on CT-angiography and -perfusion despite prophylactic medication with i.v.-nimodipine and interventional therapy (balloon angioplasty). Mean time of treatment was 4 days. Patients were kept under general anaesthesia and anticoagulated during treatment. Catheters were continuously flushed with 1–2 mg/h nimodipine.

Results: Outcome: Eight months after SAH 5 patients were free of neurological symptoms (Modified Rankin Scale (MRS) 0), 2 had good clinical recovery (MRS 1), another 2 exhibited major impairment (MRS 2), 1 patient is still in need of care (MRS 4). 1 patient was lost to follow-up.

Complications: There was one ICA-dissection extracranially treated by stenting, 3 catheters were occluded and had to be removed or renewed. These complications did not affect outcome. There was no catheter induced sepsis or embolism.

Conclusions: Continuous i.a.-nimodipine application is a potential treatment option for refractory vasospasm after aneurysmal SAH. Although all patients suffered from severe vasospasm and were at high risk for vasospasm induced ischemia our results are encouraging. The ICU management is very elaborate and time-consuming.