Barth Martin, Pena Pablo, Seiz Marcel, Thomé Claudius, Muench Elke, Weidauer Stephan, Hattingen Elke, Kasuya Hidetoshi, Schmiedek Peter
Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany.
Br J Neurosurg. 2011 Dec;25(6):677-83. doi: 10.3109/02688697.2010.548878. Epub 2011 Feb 23.
Intracisternal nicardipine prolonged release implants (NPRI) have been shown to be effective in the prophylaxis of cerebral vasospasm (VS). However, they cannot be used in patients following coil occlusion of the aneurysm. As a certain dissemination of nicardipine within the cerebrospinal fluid (CSF) has been described, we examined the feasibility of intraventricular use of NPRI in patients that underwent clip and coil occlusion of their aneurysms following aneurysmal subarachnoid haemorrhage (aSAH). By comparison with an historical control group, an estimation of their effectivity in regard to angiographic vasospasm and the development of cerebral infarction has been performed.
Thirty-one patients suffering from aSAH were prospectively included in this trial. Study participants received prior to clipping (n = 17) or coiling (n = 14) 6 (n = 15) or 10 NPRI (n = 16) into the lateral ventricles. Physiological data were collected, proximal and global VS were determined using pre-operative and day 8 ± 1 angiography, and incidence of hydrocephalus and VS related infarcts were evaluated and compared to a historical control group consisting of 16 operated patients without NPRI implantation.
Intraventricular NPRI were tolerated well. There were no adverse side effects detectable, physiological variables such as heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP) and electrolytes showed no difference compared to control. There was no difference in the proportion of patients that required CSF shunting. A significant positive angiographic effect could only be observed in clipped patients (proximal vessel diameters: control, 80 ± 30%; NPRI 90 ± 24%; incidence of moderate/severe global VS: control, 73%; NPRI, 41%).
The use of intraventricular NPRI seems to be safe and tolerated well. There is preliminary evidence for effectivity on angiographic VS for clipped patients only. A further increase of the effective dose might also exert efficacy in the subset of patients following coil occlusion.
脑池内尼卡地平缓释植入物（NPRI）已被证明在预防脑血管痉挛（VS）方面有效。然而，它们不能用于动脉瘤弹簧圈栓塞术后的患者。由于已描述了尼卡地平在脑脊液（CSF）中的一定扩散情况，我们研究了在动脉瘤性蛛网膜下腔出血（aSAH）后接受动脉瘤夹闭和弹簧圈栓塞的患者中脑室使用NPRI的可行性。通过与历史对照组比较，评估了其在血管造影性血管痉挛和脑梗死发生方面的有效性。
31例aSAH患者前瞻性纳入本试验。研究参与者在夹闭（n = 17）或弹簧圈栓塞（n = 14）前，将6个（n = 15）或10个NPRI植入侧脑室。收集生理数据，使用术前和第8±1天的血管造影确定近端和整体VS，并评估脑积水和VS相关梗死的发生率，并与由16例未植入NPRI的手术患者组成的历史对照组进行比较。
脑室内NPRI耐受性良好。未检测到不良副作用，与对照组相比，心率（HR）、平均动脉血压（MAP）、颅内压（ICP）和电解质等生理变量无差异。需要脑脊液分流的患者比例无差异。仅在夹闭患者中观察到显著的血管造影阳性效果（近端血管直径：对照组，80±30%；NPRI组，90±24%；中度/重度整体VS发生率：对照组，73%；NPRI组，41%）。
脑室内使用NPRI似乎安全且耐受性良好。仅有初步证据表明其对夹闭患者的血管造影性VS有效。进一步增加有效剂量可能对弹簧圈栓塞术后的患者亚组也有效。
