Abstract
Background: The optimal treatment for cerebral vasospasm is far from established, despite numerous trials. Intracisternal fibrinolytic therapy after clipping of aneurysm can enhance the clearance of subarachnoid blood and reduce severity of CV. The risk of infection, haemorrhage and lack of proper dosage schedule, however has precluded widespread use of cisternal irrigation. Purpose: We present a pilot study conducted to develop a protocol for cisternal irrigation, studying the efficacy and safety of the procedure. Methods: Over a period of one year, 25 patients of aneurysmal subarachnoid bleed, having Fisher grade III on CT scan and Hunt and Hess II were subdivided into study and control group. The study group receiving cisternal irrigation consisted of 9 patients and control group 16 patients. Cisternal irrigation was carried in the study group using Urokinase-Ringer lactate (UK-RL) solution (120 IU/ml) at the rate of 30 ml/hr, 12 hours after aneurysm clipping. Cerebral vasospasm was diagnosed using Sasaki's clinical criteria or TCD velocity (>120cm/second) in the middle cerebral artery. Surgical outcome at discharge and six months were assessed using Glasgow outcome scale. Results: The incidence of symptomatic vasospasm was 44.1% in the study group and 68.8% in the control group. Based on the TCD criteria, cerebral vasospasm occurred in 44.4% in the study group and 60% in the control group. The cisternal drainage duration ranged from 2 to 5 days. Total amount of drained equivalent blood was 8-155 ml. Two patients in the study group developed fatal meningitis. None of the patients developed haemorrhagic complications. Conclusion: The study revealed that cisternal irrigation remains an alternative technique to combat cerebral vasospasm. Overzealous use of antibiotics, especially with neurotoxic preservatives may be counter-productive. doi : 10.5214/ans.0972.7531.2010.170106 Competing interests: None. Source of Funding: None Received Date: 02 Dec 2009 Revised Date: 30 Dec 2009 Accepted Date: 12 Jan 2010
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