Zygourakis Corinna C, Vasudeva Viren, Lai Pui Man Rosalind, Kim Albert H, Wang Huan, Du Rose
Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Clin Neurosci. 2015 Apr;22(4):676-9. doi: 10.1016/j.jocn.2014.10.016. Epub 2015 Jan 3.
Isolated cases of transient pupillary changes after local intracisternal papaverine administration during aneurysm surgery have been reported. This study aimed to determine the prevalence and factors associated with this phenomenon. We assessed a total of 103 consecutive patients who underwent craniotomy for cerebral aneurysm clipping for the presence of postoperative pupillary dilation (mydriasis) after intracisternal papaverine administration. Univariate and multivariate logistic regression were conducted to evaluate the association of mydriasis with patient age, sex, duration of surgery, and aneurysm location. We observed either ipsilateral or bilateral pupillary dilation in the immediate postoperative period in nine out of 103 patients (8.7%). This phenomenon was not associated with patient age or sex. There was a trend towards positive correlation with aneurysms located at the anterior communicating artery (odds ratio 3.76, p=0.10), and a negative correlation with the duration of surgery (odds ratio 0.57, p=0.08). All pupillary dilation resolved within several hours, and the onset and resolution were consistent with the half-life of papaverine. To our knowledge, this represents the largest study of posteropative pupillary changes due to papaverine. The current findings are consistent with the small number of prior case reports of transient pupillary changes after papaverine administration and appear to reflect the local anesthetic action of papaverine on the oculomotor nerve.
据报道，在动脉瘤手术期间局部脑池内注射罂粟碱后出现了短暂瞳孔变化的孤立病例。本研究旨在确定这一现象的发生率及相关因素。我们评估了总共103例连续接受开颅夹闭脑动脉瘤手术的患者，以观察脑池内注射罂粟碱后是否出现术后瞳孔散大（瞳孔扩大）。进行单因素和多因素逻辑回归分析，以评估瞳孔散大与患者年龄、性别、手术时间和动脉瘤位置之间的关联。我们观察到，在103例患者中有9例（8.7%）在术后即刻出现同侧或双侧瞳孔散大。这一现象与患者年龄或性别无关。位于前交通动脉的动脉瘤有呈正相关的趋势（比值比3.76，p = 0.10），而与手术时间呈负相关（比值比0.57，p = 0.08）。所有瞳孔散大在数小时内均消失，其出现和消失与罂粟碱的半衰期一致。据我们所知，这是关于罂粟碱导致术后瞳孔变化的最大规模研究。目前的研究结果与之前少量关于罂粟碱给药后短暂瞳孔变化的病例报告一致，似乎反映了罂粟碱对动眼神经的局部麻醉作用。
