Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
Department of Neurology and Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
World Neurosurg. 2019 May;125:511-518.e1. doi: 10.1016/j.wneu.2019.01.103. Epub 2019 Jan 29.
Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH).
The authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH.
An electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used.
A total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus.
Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted.
鞘内（IT）、脑室内（IVt）和蛛网膜下腔给药将药物直接递送至中枢神经系统。这种给药途径正被作为蛛网膜下腔出血（aSAH）后血管痉挛的潜在治疗方法进行研究。
作者回顾了关于尼卡地平直接颅内给药治疗 aSAH 后血管痉挛的现有文献。
根据系统评价和荟萃分析的首选报告项目，使用 PubMed 进行了 1994 年至 2018 年期间发表的文献的电子搜索。使用了各种组合的搜索词“鞘内尼卡地平”、“脑室内尼卡地平”和“尼卡地平缓释”。
这项系统评价共纳入了 17 项研究，其中 3 项为动物研究。这些研究一致表明，IT 尼卡地平成功地逆转了血管痉挛，但正如一些研究所示，其效果仅限于药物释放的附近区域。关于长期临床结果的数据是可变的，一些研究表明明显改善，而其他研究与接受标准治疗的患者相比未能证明改善的结果。尽管不良后果并不常见，但 IT 和 IVt 给药和治疗与不良反应有关，包括头痛、脑膜炎和脑积水。
鉴于这些研究中的发现，IT、IVt 和蛛网膜下腔（微球）尼卡地平给药可作为 aSAH 后血管痉挛的有用治疗辅助手段，尤其是在对常规治疗方法有抵抗的情况下。然而，需要更大规模的对照临床试验。
