脳血管攣縮の予防のためのｎｉｃａｒｄｉｐｉｎｅ持続脳槽灌流療法の効果と灌流液のｄｅｌｉｖｅｒｙを考慮した手術における工夫
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We investigated the effect of sustained administration of intrathecal nicardipine, calcium antagonist, in 16 cases to prevent post-subarachnoid hemorrhage (SAH) vasospasm. Patients with SAH of Fisher CT Group 3 (15 cases) or Group 4 (1 case) underwent direct clipping surgery and the placement of the cisternal catheter. From 1-4 days after SAH onset, the nicardipine solution (0.09 mg/ml) was continuously injected through the cisternal catheter at the rate of 2 ml/h for 4-16 days. The vasospasm was evaluated from postoperative angiography performed 1 week after SAH onset. The ratios of diameter at internal carotid arteries (ICA) C1 portion, middle cerebral arteries (MCA) M1 portion and anterior cerebral arteries A1 portion were obtained from preoperative and post-operative angiograms. Mild localized vasospasm was observed in 5 cases. The ratios of diameter at C1, M1 and A1 were 1.15±0.19, 1.13±0.23 and 1.17±0.26, respectively. No symptomatic vasospasm was observed in any of the cases. These findings demonstrated that the vaso-dilative effect of nicardipine prevented the post SAH vasospasm of intracranial arteries at C1, M1 and A1. The mild angiographical vasospasm in the 5 cases was probably due to the insufficient delivery of nicardipine solution. Following the operative manipulation of the exposure of ICA and MCA with radical clot removal, administration of nicardipine solution through the catheter in the contralateral carotid cistern and draining from the catheter in ipsilateral sylvian cistern brought the widespread nicardipine delivery to peripheral arteries. Though further improvement of this method is required, sustained intrathecal administration of nicardipine effectively prevents vasospasm following SAH.
- 一般社団法人 日本脳卒中の外科学会の論文
一般社団法人 日本脳卒中の外科学会 | 論文
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