Kelani Hesham, Ibrahim Nancy, Naeem Ahmed, Salamah Hazem Mohamed, Al-Shafey Nada Ashraf, Tanas Yousef, Ibrahem Esraa Shawky, Naga Fawzy Mohamed Fawzy, Vulkanov Volodymyr, Jadidi Mohamed, Lerner David P, Berekashvili Ketevan, Mizrahi Moshe A, Andreev Alexander, Greene-Chandos Diana, Patsalides Athos
Neurology Department, SUNY Downstate at One Brooklyn Health, Brooklyn, NY, USA.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Neurosurg Rev. 2025 May 19;48(1):423. doi: 10.1007/s10143-025-03563-5.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Nimodipine is the only drug approved and administered orally as well as intravenously to improve the outcomes of patients with vasospasm post-SAH. EG-1962 is a sustained-release formulation of nimodipine administered into the subarachnoid space in patients with aSAH. We hypothesize that this may improve the efficacy of nimodipine and minimize its adverse effects. We searched PubMed, Cochrane, Scopus, and Web of Science on August 2, 2024, using relevant keywords. Studies were screened for eligibility. We extracted the data from the relevant articles and then these data were pooled as risk ratio (RR) and 95% confidence interval (CI), using R software. Pooled data from trials comparing intraventricular nimodipine with oral nimodipine showed a significantly lower risk of angiographic vasospasm in the intraventricular nimodipine cohort than the oral nimodipine cohort (RR = 0.8, CI [0.65-0.98]), and a trend towards lower risk of delayed cerebral ischemia and hypotension. No significant difference in extended Glasgow coma scale (eGCS) at 90 days of follow-up and other adverse events like hydrocephalus, bacterial meningitis, and serious adverse events including death. The risk of angiographic vasospasm was lower with intraventricular nimodipine compared with oral nimodipine, and there was a trend toward a decreased incidence of DCI and hypotension, which should be validated in future studies. However, there is no significant improvement in functional outcomes from intraventricular nimodipine. More rigorous research is needed to look at the underlying mechanisms and see if other factors influence the functional outcomes. Clinical trial number Not applicable.
动脉瘤性蛛网膜下腔出血（aSAH）与高发病率和死亡率相关。尼莫地平是唯一被批准口服和静脉给药以改善蛛网膜下腔出血后血管痉挛患者预后的药物。EG - 1962是一种尼莫地平的缓释制剂，用于aSAH患者的蛛网膜下腔给药。我们假设这可能会提高尼莫地平的疗效并使其不良反应最小化。我们于2024年8月2日使用相关关键词在PubMed、Cochrane、Scopus和科学网进行了检索。对研究进行资格筛选。我们从相关文章中提取数据，然后使用R软件将这些数据合并为风险比（RR）和95%置信区间（CI）。比较脑室内尼莫地平和口服尼莫地平的试验汇总数据显示，脑室内尼莫地平组的血管造影性血管痉挛风险显著低于口服尼莫地平组（RR = 0.8，CI [0.65 - 0.98]），并且延迟性脑缺血和低血压风险有降低趋势。在随访90天时的扩展格拉斯哥昏迷量表（eGCS）以及其他不良事件如脑积水、细菌性脑膜炎和包括死亡在内的严重不良事件方面无显著差异。与口服尼莫地平相比，脑室内尼莫地平的血管造影性血管痉挛风险更低，并且DCI和低血压的发生率有降低趋势，这一点应在未来研究中得到验证。然而，脑室内尼莫地平在功能预后方面并无显著改善。需要更严格的研究来探究潜在机制，看看是否有其他因素影响功能预后。临床试验编号不适用。
