Effect of Subarachnoid Injection of Papaverine on Mortality and Morbidity in Patients with Spontaneous Subarachnoid Hemorrhage and Cerebral Vasospasm

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Resident, Department of Neurosurgery, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Vasospasm has been known as one of the major causes of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). This study aimed to evaluate the effect of subarachnoid injection of papaverine on mortality and morbidity in patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm.Methods: This controlled clinical trial was conducted from 2009-2010 at Alzahra University Hospital, Isfahan (Iran). Five patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm and needing ventriculostomy were included in the intervention group and undergone ventriculostomy and received papaverine (40 mg/12 h for 72 h) injection into the subarachnoid space. 10 patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm (matching with age, sex, other disease, and subarachnoid hemorrhage severity) were included the control group and received standard treatment. Mortality, level of consciousness (GCS), hemodynamic and nervous system function changes were evaluated and compared before and 14 days after surgery.Findings: 9 women and 6 men were included in the study (mean age: 54.0 ± 12.8 years). The intervention and control groups were similar in baseline characteristics (P > 0.05). Only one person in the control group and none of the intervention group died two weeks after surgery (P = 0.667). After two weeks, mean of GCS had significant improvement in the intervention group (from 8.2 ± 1.6 to 12.8 ± 2.6; P < 0.008) but no change was seen in the control group (from 8.8 ± 1.8 to 9.0 ± 1.8; P = 0.729).Conclusion: This study indicated that a significant clinical improvement occurred after subarachnoid injection of papaverine in patients with spontaneous subarachnoid hemorrhage accompanied by cerebral vasospasm. This treatment has no beneficial effects on nervous complications. Future studies with larger sample size and longer follow-ups are recommended.

Keywords

References

  1. Schievink WI. Intracranial aneurysms. N Engl J Med 1997; 336(1): 1758-9.
  2. Mayberg MR, Okada T, Bark DH. Morphologic changes in cerebral arteries after subarachnoid hemorrhage. Neurosurg Clin N Am 1990; 1(2): 417-32.
  3. Wickman G, Lan C, Vollrath B. Functional roles of the rho/rho kinase pathway and protein kinase C in the regulation of cerebrovascular constriction mediated by hemoglobin: relevance to subarachnoid hemorrhage and vasospasm. Circ Res 2003; 92(7): 809-16.
  4. Torbey MT, Hauser TK, Bhardwaj A, Williams MA, Ulatowski JA, Mirski MA, et al. Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001; 32(9): 2005-11.
  5. Conway JE, Tamargo RJ. Cocaine use is an independent risk factor for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001; 32(10): 2338-43.
  6. Qureshi AI, Suri MF, Yahia AM, Suarez JI, Guterman LR, Hopkins LN, et al. Risk factors for subarachnoid hemorrhage. Neurosurgery 2001; 49(3): 607-12.
  7. Dalbasti T, Karabiyikoglu M, Ozdamar N, Oktar N, Cagli S. Efficacy of controlled-release papaverine pellets in preventing symptomatic cerebral vasospasm. J Neurosurg 2001; 95(1): 44-50.
  8. Smith WS, Dowd CF, Johnston SC, Ko NU, DeArmond SJ, Dillon WP, et al. Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2004; 35(11): 2518-22.
  9. Ausman JI, Slavin KV, Charbel FT. Commentary to the article "Pupillary changes after intracisternal injection of papaverine" by M. Pritz. Surg Neurol 1994; 41(4): 283.
  10. Bala I, Ghai B, Kumar A, Pratap M. Bilateral pupillary dilatation after intracisternal papaverine application. Anesth Analg 2006; 102(3): 965.
  11. Lang EW, Neugebauer M, Ng K, Fung V, Clouston P, Dorsch NW. Facial nerve palsy after intracisternal papaverine application during aneurysm surgery--case report. Neurol Med Chir (Tokyo) 2002; 42(12): 565-7.
  12. Pritz MB. Pupillary changes after intracisternal injection of papaverine. Surg Neurol 1994; 41(4): 281-2.
  13. Rath GP, Mukta, Prabhakar H, Dash HH, Suri A. Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery. Br J Anaesth 2006; 97(6): 848-50.
  14. Chia RY, Hughes RS, Morgan MK. Magnesium: a useful adjunct in the prevention of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. J Clin Neurosci 2002; 9(3): 279-81.
  15. Dehdashti AR, Mermillod B, Rufenacht DA, Reverdin A, de TN. Does treatment modality of intracranial ruptured aneurysms influence the incidence of cerebral vasospasm and clinical outcome? Cerebrovasc Dis 2004; 17(1): 53-60.
  16. Roos YB, de Haan RJ, Beenen LF, Groen RJ, Albrecht KW, Vermeulen M. Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands. J Neurol Neurosurg Psychiatry 2000; 68(3): 337-41.
  17. Liu JK, Tenner MS, Gottfried ON, Stevens EA, Rosenow JM, Madan N, et al. Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm. J Neurosurg 2004; 100(3): 414-21.
Journal of Isfahan Medical School
Volume 29, Issue 156 - Serial Number 156
July and August 2011
Pages 1478-1483

Files

History

  • Receive Date: 03 April 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics