gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Article

Send article

Effects of continuous intraarterial nimodepine treatment of vasospasm following aneurysmal subarachnoid hemorrhage

Meeting Abstract

Search Medline for

  • Konstantin Hockel - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
  • Jochen Steiner - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
  • Ulrich Birkenhauer - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
  • Sören Danz - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen, Tübingen
  • Martin U. Schuhmann - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.11.04

doi: 10.3205/13dgnc267, urn:nbn:de:0183-13dgnc2670

Published: May 21, 2013

© 2013 Hockel 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

Text

Objective: Delayed cerebral ischemia (DCI) is one main reasons of unfavorable outcome following aneurysmal subarachnoid hemorrhage (SAH). Secondary macrovasospasm and disturbance of cerebrovascular autoregulation have been identified as associated risk factors. Interventional spasmolysis with application of papaverin or nimodepine was shown to be effective on vessel diameter, however with transient effects only. We evaluated the effects of continuous intraarterial nimodepine infusion (CIN) on macrovasospasm, autoregulation and outcome in selected patients with refractory severe vasospasm.

Method: 10 patients (8 female, 2 male, mean age 39y) were included with either refractory vasospasm and infarctions despite interventional spasmolysis (n=4) or primary severe vasospasm. Patients had continuous multimodal neuromonitoring (ABP, ICP, pbrO2), daily transcranial doppler (TCD) exams, and CT-angiography (CTA) if indicated. ICM+ software was used to calculate CPP and cerebrovascular autoregulation indices PRx and ORx. Prowler microcatheters were placed in (both) extracranial internal carotid arteries (ICA) and 0.4 mg nimodepine in 50 ml/h was infused each. Patients were heparinized (to PTT 60s).

Results: Mean duration of spasmolysis was 12.0 days (range 9-15). ICP remained stable, TCD flow velocity decreased, pbrO2 improved by 37%, vasospasm according to CTA was improved (n=5) or disappeared (n=5) at the end of treatment. Cerebrovascular autoregulation, however, was lost during treatment according to PRx and ORx. Two patients suffered additional small infarcts, however, outcome at discharge was GOS 4&5 in all 10 patients. In 2/10 patients minor complications (catheter dislocation, extracerebral bleed) were seen.

Conclusions: CIN treatment according to our protocol was save and seems effective in preventing DCI in selected patients with severe vasospasm and high risk profile for unfavorable outcome. Despite the fact, that nimodepine lead to loss of cerebrovascular autoregulation, which per se is known to be associated with DCI under standard treatment, the overall effect on macrovasospasm and tissue perfusion was beneficial. A possible contribution of heparinization cannot be excluded. A randomized prospective study with larger patient numbers is necessary to confirm the efficacy of CIN in the prevention of DCI.