Beneficial effects of cisternal injection of urokinase (UK) and nicardipine in patients with ruptured intracranial aneurysms were studied. Eighty-two patients with ruptured aneurysms, who were graded II to IV according to Hunt & Hess' classification and underwent early surgery with ventricular and cisternal drainages, were injected with UK (6000-12000 i.u.) and nicardipine (1-2mg) via the cisternal catheter twice a day for 7 to 21 days after surgery. The rate of symptomatic vasospasm (SVS) and outcome of the patients in the treated group were compared with those in 134 patients treated only with early operation and drainages without the cisternal injections. Neurological deficits due to SVS (permanent SVS) were observed in 2 (2%) of 83 patients treated with the cisternal administration of UK and nicardipine, while permanent SVS deficits were observed in 22 (16%) of 134 patients without cisternal injections. A good outcome was significantly higher in the treated group than in the non-treated group. The amount of hemoglobin in cerebrospinal fluid from cisternal catheters increased markedly during the cisternal injections of UK. Regional cerebral blood flow measured by SPECT with 133Xe inhalation increased during the treatment with nicardipine. The present study suggested that cisternal administration of UK and nicardipine is useful for patients with ruptured aneurysms.
