Mikeladze K G, Bykanov A E, Vinogradov E V, Okishev D N, Pitskhelauri D I, Kobyakov G L, Abramov I T, Yakovlev S B
Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(2):88-94. doi: 10.17116/oftalma201882288-94.
We describe our experience of using intra-arterial administration of Verapamil to resolve vasospasm in two patients who underwent surgery for insular glial tumors.
Severe vasospasm (an increased systolic LBFV in the M1 MCA, more than 250 cm/s, and a Lindegaard index of 4.1) was observed in 2 (3.2%) of 62 patients in the early postoperative period after removal of intracerebral insular tumors. In both cases, vasospasm was confirmed by angiography, was clinically significant, and manifested by the development of pyramidal hemisyndrome.
Intra-arterial administration of Verapamil led to relief of angiospasm, which was confirmed by angiographic data, and complete regression of neurological symptoms.
Vasospasm symptoms in patients after removal of insular tumors largely resemble those after aneurysm hemorrhage. An increase in the LBFV in the MCA and related neurological symptoms develop lately and persists for up to 2 weeks after surgery. LBFV values are similar to those in patients after SAH and reach 250-300 cm/s. Among the causes of focal symptoms developed after removal of insular tumors, injury to the inner capsule structures, injury to arteries of the MCA territory (especially perforators), and angiospasm should be differentiated.
我们描述了使用维拉帕米动脉内给药来缓解两名接受岛叶胶质瘤手术患者血管痉挛的经验。
在62例脑岛肿瘤切除术后早期患者中，有2例（3.2%）观察到严重血管痉挛（大脑中动脉M1段收缩期局部脑血流速度增加，超过250 cm/s，林德加德指数为4.1）。在这两例中，血管痉挛均经血管造影证实，具有临床意义，并表现为锥体束半侧综合征。
维拉帕米动脉内给药导致血管痉挛缓解，血管造影数据证实了这一点，且神经症状完全消退。
岛叶肿瘤切除术后患者的血管痉挛症状与动脉瘤出血后的症状大致相似。大脑中动脉局部脑血流速度增加及相关神经症状出现较晚，术后可持续长达2周。局部脑血流速度值与蛛网膜下腔出血患者相似，可达250 - 300 cm/s。在岛叶肿瘤切除术后出现局灶性症状的原因中，应区分内囊结构损伤、大脑中动脉区域动脉损伤（尤其是穿支动脉）和血管痉挛。
