Division of Neurosurgery, Department of Surgery, University of Missouri Hospital and Clinics, Columbia, Missouri, USA.
Department of Neurology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA.
World Neurosurg. 2019 May;125:247-252. doi: 10.1016/j.wneu.2019.01.239. Epub 2019 Feb 15.
Dantrolene has a safe side-effect profile and a mechanism of action that makes it attractive as an option for treatment of cerebral vasospasm. The authors report 2 cases of refractory cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage that were successfully treated with intra-arterial (IA) dantrolene.
Two patients, a 63-year-old woman and 36-year-old woman, developed severe vasospasm refractory to IA vasodilators after rupture of anterior communicating artery aneurysms. IA dantrolene was injected in doses of 15-30 mg in the affected distributions and mean arterial pressure, intracranial pressure, and heart rate were monitored. There was immediate improvement in lumen diameter of the affected vessels following dantrolene injection. No significant differences in mean arterial pressure or intracranial pressure before and after IA dantrolene were observed. Both patients demonstrated clinical improvement within 24 hours without any further deterioration during the rest of their admission. Follow-up angiography 48 hours after IA dantrolene treatment demonstrated continued resolution of cerebral vasospasm.
This evidence suggests IA dantrolene as a safe and effective novel alternative for the treatment of cerebral vasospasm.
丹曲林具有安全的副作用谱和作用机制，使其成为治疗脑血管痉挛的一种有吸引力的选择。作者报告了 2 例因颅内动脉瘤性蛛网膜下腔出血引起的难治性脑血管痉挛，用动脉内（IA）丹曲林成功治疗。
两名患者，一名 63 岁女性和一名 36 岁女性，在前交通动脉瘤破裂后出现严重的血管痉挛，对 IA 血管扩张剂治疗无效。IA 丹曲林的剂量为 15-30mg，在受影响的部位给药，并监测平均动脉压、颅内压和心率。丹曲林注射后，受影响的血管管腔直径立即改善。IA 丹曲林前后平均动脉压或颅内压无明显差异。两名患者在 24 小时内均表现出临床改善，在住院期间无进一步恶化。IA 丹曲林治疗后 48 小时的随访血管造影显示脑血管痉挛持续缓解。
这一证据表明 IA 丹曲林是治疗脑血管痉挛的一种安全有效的新型替代方法。
