Artikel
Neuroprotective efficacy of prophylactic enteral and parenteral nimodipine treatment in vestibular schwannoma surgery – a comparative study
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Autoren
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Christian Scheller
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
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Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, University of Halle-Wittenberg, Germany
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Franziska Wurm
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
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Sebastian Simmermacher
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
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Stefan Rampp
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
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Gershom Koman
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
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Christian Strauss
- Department of Neurosurgery, University of Halle-Wittenberg, Germany
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: Pharmacokinetic investigations showed nimodipine to reach higher serum levels following parenteral than after enteral administration. Furthermore a correlation between nimodipine levels in serum, cerebrospinal fluid (CSF) and nerve tissue could be quantified. These observations raise the question if the proven neuroprotective effect of nimodipine is related to its serum level.
Method: A consecutive series of 37 patients suffering from vestibular schwannomas (VS) and treated with nimodipine prophylaxis from the day before surgery until the seventh postoperative day was analyzed retrospectively. Both groups received standard dosages for enteral (n=17) and parenteral (n=20) nimodipine medication. Nimodipine levels were measured in serum, CSF, and tissue samples including vestibular nerves. Cochlear and facial nerve functions were documented before surgery, in the early postoperative course and one year after surgery.
Results: Both groups were comparable regarding tumor size (with a tendency for larger tumors in the group with parenteral treatment) and extent of resection. Both intraoperative (p=0.004) and postoperative (p=0.001) nimodipine serum levels were significantly higher following parenteral administration as compared to enteral administration. Logistical regression analysis revealed a seven times smaller risk for a deterioration of facial nerve function in the group with parenteral treatment. Facial nerve outcome was statistical significant better in the group with parenteral nimodipine medication (p=0.038). There was no difference in hearing preservation between both groups despite tumor size tending to be larger in the parenteral group.
Conclusions: These results support a dependency of nimodipine neuroprotective efficacy on its serum levels, and therefore its way of administration. Parenteral nimodipine treatment produces higher serum levels and has higher neuroprotective potency in VS surgery as compared to enteral treatment. Prospective studies with more patients should be performed. The findings may be transferable to patients suffering from other skull base lesions and subarachnoid hemorrhage.
