Treatment of subarachnoid hemorrhage in the acute stage is still controversial. Nicardipine, one of Ca++ antagonist, is considered to have vasodilating effect on cerebral arteries. Some favorable experimental results of effectiveness of nicardipine on cerebral vasospasm has been reported.
Authors evaluated the effect of cisternal irrigation with nicardipine-Ringer solution (0.01mg/ml) to prevent human cerebral vasospasm.
In 16 cases with 3 or 4 CT group operated upon within 48 hours after subarachnoid hemorrhage due to cerebral aneurysm, irrigation was carried out for 14 days on an average after aneurysmal clipping. As nicardipine is concentration dependent agent, it is necessary to keep effective concentration of nicardipine during irrigation. Cisterno-cisternal irrigation was performed from sylvian cistern and/or interhemispheric cistern to prepontine cistern, instead of ventriculo-cisternal irrigation, with which nicardipine is diluted by cerebro-spinal fluid.
Symptomatic vasospasm was found in 50% of 16 cases. In 62% of cases vasospasm was observed in at least one of three main branches; i. e., anterior cerebral artery (Al), middle cerebral artery (Ml) and internal carotid artery (Cl). Half of cases were excellent or good results and no fatal case due to vasospasm was found. These results were compared favorably with our 185 reported cases without nicardipine irrigation.
Cisternal irrigation with nicardipine may prevent vasospasm and improve the prognosis of severe subarachnoid hemorrhage due to ruptured aneurysm.
