Abstract
Cerebral vasospasm (CVS) is a frequent and serious neurosurgical complication, without sufficient therapy. This retrospective study was performed to analyze if nimodipine can improve prognosis and reduce ischaemia secondary to delayed CVS after intracranial tumour surgery. A retrospective review was performed over the years 2011 to 2012 for patients with an anterior cranial fossa tumour and underwent intracranial tumour surgery. The surgical field was soaked with nimodipine solution or normal saline. Transcranial Doppler ultrasonography was used to measure velocity in the middle cerebral artery (MCA) and the distal extracranial internal carotid artery (eICA). Follow-up was performed using the Glasgow Outcome Scale (GOS) after discharge. There were 94 patients that met the inclusion criteria. They included 50males and 44 females, with a mean age of 49.6years. In the nimodipine group, CVS occurred in 13 patients; 9 patients had CVS between 4 and 7days, and 4had CVS between 8 and 14days. In the normal saline group, 19 patients had CVS, 3 presented with CVS within 3days, 11 between 4-7days and 5 between 8-14days. A significant difference in the occurrence of CVS was observed between the two groups. Preoperative and postoperative the MCA velocities were compared, revealing a significant change in the normal saline group but not in the nimodipine group. Nimodipine markedly improves prognosis and significantly reduces ischaemia secondary to delayed CVS after intracranial tumour surgery, as well as the risks of mortality and morbidity.
Highlights
Cerebral vasospasm (CVS) is a serious neurosurgical complication[1, 2]
We showed that administration of nimodipine during and after surgery can effectively prevent the occurrence of delayed CVS and improves the prognosis of CVS
Potential causes of CVS are as follows: 1. mechanical stimulation such as damage, compression or stretching of the blood vessels during surgery, leading to the blood flowing into the subarachnoid space and subsequent occurrence of CVS occurs[17]; 2. vascular wall injury caused by compression of the vascular wall and vascular wall malnutrition[18]; 3. damage caused by the oxidation of hemoglobin to methemoglobin and release of oxygen free radicals[19]; 4. constriction of the blood vessels caused by vasoactive substances[20]; 5. increased intracranial pressure, the overdose of dehydration drugs and insufficient supply of blood volume[21]; and 6. inflammation and immune reactions of blood vessel walls[7, 22, 23]
Summary
Cerebral vasospasm (CVS) is a serious neurosurgical complication[1, 2]. Currently, studies are focused on CVS induced by subarachnoid hemorrhage (SAH) caused by arterial aneurysm and traumatic SAH[3, 4]. Only a few cases have been reported regarding delayed CVS after intracranial tumor surgery[5,6,7], and clinicians have paid less attention to this issue. It has been shown that the incidence of CVS after intracranial tumor surgery is relatively high (22–49%), especially if an immediate diagnosis and/or treatment is delayed, decreasing the effectiveness of surgery[8, 9]. Cerebral vasospasm (CVS) is a serious neurosurgical complication. This retrospective study was performed to analyze if nimodipine can improve prognosis and reduces ischemia secondary to delayed CVS after intracranial tumor surgery
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