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

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Selective intraarterial nimodipine application in severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Meeting Abstract

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  • Josef Michael Lang - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • Friedrich Götz - Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover
  • Joachim K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover

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. DocMI.12.06

doi: 10.3205/13dgnc380, urn:nbn:de:0183-13dgnc3806

Published: May 21, 2013

© 2013 Lang 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: To evaluate the effectivness of selective intraarterial nimodipine admini-stration in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Method: 23 consecutive patients (6 male, 17 female, 22 to 77 years old) with severe medically refractory cerebral vasospasm were treated. A multifactorial decision tree was used to determine the indication for digital substraction angiography and selective intraarterial nimodipine application in a standardized regimen (2 mg nimodipine diluted with 20 ml 0,9 % NaCl and an infusion rate of 1 ml/min). Effectiveness was prospectively rated regarding vessel caliber modifications and neurological course.

Results: Totally, 46 vessel territories (39 in the anterior circulation, 7 in the posterior circulation) in the 23 patients were endovascularly infused with nimodipine. An angiographic effect was observed in 22 of 23 (95,6%) patients. In 7 (31,8%) patients the effect was good (remarkable enlargement in vessel caliber) and moderate (minor vessel caliber improvement) in 15 patients (68, 2%). In one patient there was no effect. Clinically, in 11 patients (47,8 %) neurologic deficits ameliorated, in 12 patients (52,2%) no improvement of neurologic status was observed. Four patients (17,4%) died due to vasospasm related multiple infarctions. In two patients (8,7%) a decrease of blood pressure was noticed during intraarterial administration of nimodipine. No severe adverse effects were noted.

Conclusions: Selective intraarterial nimodipine application in severe cerebral vasospasm should be considered a therapeutical option in selected cases.