Etiology and Treatment of Vasospasm following Subarachnoid Hemorrhage

概要

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In our recent study, biochemical analysis of spasmegenic substances released from blood or a blood-CSF mixture has been performed. These vasoactive substances were applied in both in vitro and in vivo experiments and it was found that oxyhemoglobin or its allied polypeptide, produced in the process of clot lysis or during the breakdown of blood corpuscles, was the main causative substance for prolonged vasospasm. In this study, morphological examination using the fluorescent antibody and the ferritin antibody methods were undertaken to gain a better understanding of the mechanism of spasmogenic reaction of hemoglobin on cerebral vessels. Hemoglobin was found to be distributed in the adventitia and in the smooth muscle layer of the media. Haptoglobin, which is a normal constituent of serum, is known to bind with hemoglobin to form a chemically stable hemoglobin-haptaglobin compound. Vasospasm was released by the application of haptoglobin both in vitro and in vivo. Based on these experimental results, clinical use of haptoglobin was made in 27 patients with vasospasm. In 17 cases, anglographical spasm was progressively increased or decreased on the the day prior to surgery. Fourteen of the 17 cases showed angiographical improvement of vasospasm after use of haptoglobin. We also discuss the development of postoperative vasospasm due to the operation itself.
日本脳神経外科学会の論文
1979-01-15