Prevention of Vasospasm due to Serious Subarachnoid Hemorrhage

Abstract

Numerous approaches to the prevention and treatment of cerebral vasospasm have been reported recently, but the effect of these methods is still controversial. The authors have evaluated the effect of administering cisternal irrigation with nicardipine-Ringer solution (0.01mg/ml) or continuous intravenous nitroglycerin (GTN) infusion to prevent cerebral vasospasm.
One hundred forty consecutive patients classified as CT Group 3 or 4 were operated on within 48 hours after subarachnoid hemorrhage due to cerebral aneurysm. In nineteen cases, cisternal irrigation with nicardipine was carried out for 14 days on an average after aneurysmal clipping. Another fifteen patients were treated with continuous intravenous infusion of GTN (0.5-1.0μg/kg/min.).
Neither method prevented angiographic vasospasm, but they reduced the severity of the vasocontraction. They significantly reduced the mortality of aneurysm surgery in high-risk patients. In each group, good or excellent results were obtained in almost half of the cases, and no fatality due to vasospasm occurred. These results indicate that both cisternal irrigation with nicardipine and continuous intravenous GTN infusion may prevent severe vasospasm and improve the prognosis of serious subarachnoid hemorrhage due to a ruptured aneurysm.