J Korean Neurosurg Soc.  2001 Mar;30(3):325-333.

Effect of the Intra-arterial Papaverine Infusion on the Symptomatic Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

• Shin JJ
• Lee JW
• Shin YS
• Huh SK
• Kim DI
• Lee KC

Abstract

OBJECTIVES
To clarify the benefits and therapeutic effects of intra-arterial papaverine infusion on the symptomatic cerebral vasospasm, we analyzed the results of treatment in 32 patients retrospectively.
METHODS
A total of 510 patients underwent surgical clipping or endovascular intra-aneurysmal treatment for ruptured intracranial aneurysm between May, 1996 and June, 1999. The delayed ischemic deficit(DID) was developed in 90 of 510 patients. Of these 90 patients, 32 developed symptomatic vasospasm inspite of using modest "3H therapy". The brain CT scan was taken before the intra-arterial infusion of papaverine. The 32 patients underwent 42 intra-arterial papaverine infusion. The symptomatic vasospasm was divided into three groups: deterioration of mental status(Group 1), appearance of a focal neurologic deficit(Group 2), or both(Group 3). We measured Glasgow Coma Scale(GCS), arterial diameters, and cerebral circulation time(CCT) at the time of pre- and postangioplasty.
RESULTS
The number of patients in group 1, 2 and 3 were 26, 7, 9 respectively. Eighteen cases showed improvement of GCS more than 2 scores, 16 more than 1, and 8 showed no change of GCS. Average cerebral circulation time(CCT) was decreased ranging from 0.0%-67.5%, and arterial diameters were increased in 21 cases ranging from 1 to 4 folds.
CONCLUSION
Intra-arterial papaverine infusion seemed to have therapeutic effects on symptomatic vasospasm by improving the neurological signs and increasing the arterial diameter. We suggest that intra-arterial papaverine infusion would be an useful adjunctive therapeutic modality in symptomatic vasospasm.

Keyword

Subarachnoid hemorrhage; Symptomatic vasospasm; Intra-arterial papaverine infusion

MeSH Terms

Aneurysm*
Brain
Coma
Humans
Infusions, Intra-Arterial
Intracranial Aneurysm
Papaverine*
Retrospective Studies
Subarachnoid Hemorrhage*
Surgical Instruments
Tomography, X-Ray Computed
Vasospasm, Intracranial*
Papaverine