Liu James K, Tenner Michael S, Gottfried Oren N, Stevens Edwin A, Rosenow Joshua M, Madan Neel, MacDonald Joel D, Kestle John R W, Couldwell William T
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
J Neurosurg. 2004 Mar;100(3):414-21. doi: 10.3171/jns.2004.100.3.0414.
Cerebral vasospasm that is caused by aneurysmal subarachnoid hemorrhage and that is refractory to maximal medical management can be treated with selective intraarterial papaverine infusions. The effects of single papaverine treatments on cerebral circulation time are well known. The purpose of this study was to assess the efficacy of multiple, repeated papaverine infusions on the cerebral circulation time in patients with recurrent vasospasm.
A retrospective study was conducted in 17 patients who received multiple intraarterial papaverine infusions in 91 carotid artery (CA) territories for the treatment of cerebral vasospasm. Cerebral circulation times were measured from the first angiographic image, in which peak contrast was seen above the supraclinoid internal CA, to the peak filling of cortical veins. Glasgow Outcome Scale (GOS) scores assessed 12 months after discharge were reviewed. Cerebral circulation times in 16 CA territories were measured in a control group of 11 patients. Seventeen patients received a total of 91 papaverine treatments. Prolonged cerebral circulation times improved after 90 (99%) of 91 papaverine treatments. The prepapaverine mean cerebral circulation time was 6.54 seconds (range 3.35-27 seconds) and the immediate postpapaverine mean cerebral circulation time was 4.19 seconds (range 2.1-12.6 seconds), an overall mean decrease of 2.35 seconds (36%, p < 0.001). Recurrent vasospasm reflected by prolonged cerebral circulation times continued to improve with subsequent papaverine infusions. Repeated infusions were just as successful quantitatively as the primary treatment (mean change 2.06 seconds). The mean cerebral circulation time in the control group was 5.21 seconds (range 4-6.8 seconds). In five patients a dramatic reversal of low-attenuation changes was detected on computerized tomography scans. The mean GOS score at 12 months after discharge was 3.4.
The preliminary results indicate that multiple intraarterial papaverine treatments consistently improve cerebral circulation times, even with repeated infusions in cases of recurrent vasospasm.
由动脉瘤性蛛网膜下腔出血引起且对最大程度的药物治疗无效的脑血管痉挛，可通过选择性动脉内注入罂粟碱进行治疗。单次罂粟碱治疗对脑循环时间的影响是众所周知的。本研究的目的是评估多次重复注入罂粟碱对复发性血管痉挛患者脑循环时间的疗效。
对17例患者进行回顾性研究，这些患者在91个颈动脉区域接受了多次动脉内注入罂粟碱以治疗脑血管痉挛。脑循环时间从第一张血管造影图像开始测量，在该图像中，鞍上颈内动脉上方可见造影剂峰值，直至皮质静脉的峰值充盈。回顾出院后12个月评估的格拉斯哥预后量表（GOS）评分。在11例患者的对照组中测量了16个颈动脉区域的脑循环时间。17例患者共接受了91次罂粟碱治疗。91次罂粟碱治疗中的90次（99%）后，延长的脑循环时间得到改善。注入罂粟碱前的平均脑循环时间为6.54秒（范围3.35 - 27秒），注入罂粟碱后的即时平均脑循环时间为4.19秒（范围2.1 - 12.6秒），总体平均减少2.35秒（36%，p < 0.001）。由延长的脑循环时间反映的复发性血管痉挛在随后的罂粟碱注入后持续改善。重复注入在定量方面与初次治疗同样成功（平均变化2.06秒）。对照组的平均脑循环时间为5.21秒（范围4 - 6.8秒）。在5例患者中，计算机断层扫描检测到低密度改变有显著逆转。出院后12个月的平均GOS评分为3.4。
初步结果表明，多次动脉内注入罂粟碱治疗能持续改善脑循环时间，即使在复发性血管痉挛的情况下重复注入也是如此。
