Abstract
We studied the efficacy of cisternal injection of urokinase (UK) and nicardipine for prevention of symptomatic vasospasm (SVS) in patients with ruptured intracranial aneurysms. Two-hundred and fifty-eight patients who were classed into Group 2 to 4 according to Fisher's computed tomographic classification and underwent early surgery with ventricular and cisternal drainage were given UK (6000-12000 I. U.) and nicardipine (1-2mg) via the cisternal catheter twice each day for 6 and 9 days, respectively, after surgery (the treated group). These patients were further subclassified into the 2 groups of the treated Group I, 194 patients treated between 1989 and 1993, and the treated Group II, 64 patients treated in 1994. The rate of SVS and outcome in the treated groups were compared with those in 153 patients who underwent early surgery and were treated with ventricular and cisternal drainage without the cisternal injection of the drugs (the control group).
Permanent neurological deficits due to vasospasm were observed in 6 (3%) patients in the treated Group I, 1 (2%) in the treated Group II, and in 22 (14%) in the control group. The outcome was significantly better in the 2 treated groups than in the control group, and there was no difference between the treated groups in outcome. The amount of hemoglobin in cerebrospinal fluid collected from the cisternal catheter in the treated Group I (n=7) was greater than that in the control group (n=12) in the early period after the surgery. The regional cerebral blood flow measured by SPECT with 133Xe inhalation was increased during the treatment with nicardipine (n=4).
These results suggest that cisternal administration of UK and nicardipine is useful for the prevention of severe SVS in patients with ruptured aneurysms.
