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

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Continuous selective intraarterial infusion of nimodipine for therapy of refractory cerebral vasospasm

Meeting Abstract

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  • S. Ott - Abteilung für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen der Technischen Universität München
  • S. Wolf - Abteilung für Neurochirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
  • S.O. Rodiek - Abteilung für Radiologie, Akademisches Lehrkrankenhaus München-Bogenhausen der Technischen Universität München
  • L. Schürer - Abteilung für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen der Technischen Universität München
  • C. Lumenta - Abteilung für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen der Technischen Universität München

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.07.10

doi: 10.3205/12dgnc066, urn:nbn:de:0183-12dgnc0667

Published: June 4, 2012

© 2012 Ott 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: For endovascular treatment of vasospasm after aneurysmal subarachnoid hemorrhage (aSAH), an intraarterial treatment course with the calcium channel antagonist nimodipine infused for 30 min is proposed. As some patients still show ongoing vasospasm thereafter, we report our experience with an extended time period of selective intraarterial nimodipine administration.

Methods: In twenty patients with aSAH and refractory vasospasm, we left the catheter in place within the internal carotid artery after angiography. On the neurosurgical intensive care unit, a continuous infusion of intraarterial nimodipine was commenced, combined with intraarterial heparin anticoagulation. Therapy was controlled with extended neuromonitoring techniques.

Results: Four patients died from refractory vasospasm and a fifth suffered lethal sepsis. Fifteen patients survived in a good clinical condition, based on their Hunt&Hess grade. Seven of them recovered without an apparent neurological deficit. The efficacy of intraarterial nimodipine was best verified with regional cerebral blood flow monitoring. Transcranial doppler turned out to be unreliable with interexaminer variance and failure of detecting vasospasm or missing the improvement in some patients. Brain tissue oxygenation increased, but was not indicative of vasospasm. Computed tomography perfusion scanning reflected the treatment course adequately.

Conclusions: Selective continuous intraarterial nimodipine treatment for refractory cerebral vasospasm after aSAH seems feasible and may add to the endovascular therapeutic options. Appropriate monitoring technology is essential for further investigations of this novel technique.