Visocchi M, Argiolas L, Meglio M, Cioni B, Basso P D, Rollo M, Cabezas D
Institute of Neurosurgery, Catholic University, Rome, Italy.
Acta Neurochir (Wien). 2001;143(2):177-85. doi: 10.1007/s007010170126.
Clinical and experimental data on cerebral blood flow (CBF) changes during spinal cord stimulation (SCS) were published since 1986. The aims of the present work are: 1. To find an experimental model of reliable, simple and in vivo monitoring of "early" basilar artery spasm after subarachnoid haemorrhage (SAH) and 2. To investigate the effects of cervical spinal cord stimulation (CSCS) on it. Vasospasm due to SAH is both "acute" and "recurrent". Early spasm occurs within minutes of the SAH. its duration is approximately 1 hour. The need of different morphological and haemodynamic methods to evaluate experimental early spasm is reported. To overcome intracranial surgical manipulations and biological effects of contrast and fixation media we designed a model that allows "in vivo" functional monitoring of basilar blood flow far away from the spasm without direct surgical and chemical interference. Subsequently we investigated the effects of CSCS on the new model of "functional monitoring" of the "early" cerebral vasospasm.
29 adult Burgundy rabbits were studied. Group 1: under homeostatic monitoring, "on-line" carotid blood flow (carotid BF) changes produced by SAH in cisterna magna of 12 (plus 5 sham treated) animals were studied from the common carotid artery after external carotid artery occlusion before, during SAH and up to the end of the experiments. All the animals underwent digital subtraction cerebral panangiography (CPA) after SAH obtaining a significant increase of carotid BF only when basilar vasospasm was shown by CPA. Carotid BF increase during basilar vasospasm was defined "functional monitoring" of early spasm. Group 2: Twelve animals wearing a cervical epidural electrode underwent carotid BF "functional monitoring" of early basilar spasm before and during CSCS.
Carotid BF changes during CSCS occurred in 10 animals. No carotid BF changes (i.e. no basilar vasospasm) occurred after SAH up to the end of the experiments in all the stimulated animals.
CSCS is able to prevent "early spasm" due to SAH in all the animals studied with the new model of "functional monitoring" described, independently from the occurence and the sign for stimulation-induced carotid BF variations. The role and the limits of reversible functional sympathectomy in mediating the effect of CSCS on early vasospam are discussed.
自1986年以来，已发表了关于脊髓刺激（SCS）期间脑血流量（CBF）变化的临床和实验数据。本研究的目的是：1. 找到一种可靠、简单且能在体内监测蛛网膜下腔出血（SAH）后“早期”基底动脉痉挛的实验模型；2. 研究颈脊髓刺激（CSCS）对其的影响。SAH引起的血管痉挛既有“急性”的，也有“复发性”的。早期痉挛在SAH后几分钟内发生，持续时间约为1小时。有报道称需要不同的形态学和血流动力学方法来评估实验性早期痉挛。为了克服颅内手术操作以及造影剂和固定介质的生物学效应，我们设计了一种模型，该模型可以在不进行直接手术和化学干扰的情况下，对远离痉挛部位的基底血流进行“体内”功能监测。随后，我们研究了CSCS对“早期”脑血管痉挛“功能监测”新模型的影响。
对29只成年勃艮第兔进行研究。第1组：在稳态监测下，研究了12只（另外5只接受假手术处理）动物在蛛网膜下腔注射SAH后，从颈总动脉记录的“在线”颈血流量（颈动脉BF）变化，在SAH前、SAH期间以及实验结束时均进行记录，此时颈外动脉已被阻断。所有动物在SAH后均接受数字减影全脑血管造影（CPA），只有当CPA显示基底动脉痉挛时，颈动脉BF才会显著增加。基底动脉痉挛期间颈动脉BF的增加被定义为早期痉挛的“功能监测”。第2组：12只佩戴颈段硬膜外电极的动物在CSCS前和CSCS期间接受早期基底动脉痉挛的颈动脉BF“功能监测”。
10只动物在CSCS期间出现了颈动脉BF变化。在所有接受刺激的动物中，直到实验结束，SAH后均未出现颈动脉BF变化（即无基底动脉痉挛）。
使用所描述的“功能监测”新模型，在所有研究的动物中，CSCS能够预防SAH引起的“早期痉挛”，这与刺激诱导的颈动脉BF变化的发生情况和迹象无关。讨论了可逆性功能交感神经切除术在介导CSCS对早期血管痉挛作用中的作用和局限性。
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