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Transient bilateral brainstem dysfunction caused by topical administration of papaverine
Colleen M Moran1, Michael E Mahla, Brett Reichwage
1Departments of Anesthesiology.
Journal of Neurosurgery
|July 5, 2011
Summary
Topical papaverine during craniotomy may cause temporary brainstem dysfunction, affecting somatosensory evoked potentials. These transient effects in patients suggest direct papaverine impact, not requiring aggressive intervention.
Area of Science:
- Neurosurgery
- Neurophysiology
Background:
- Papaverine is used topically during craniotomy.
- Transient cranial nerve dysfunction has been linked to topical papaverine use.
Purpose of the Study:
- To investigate the effects of topical papaverine on brainstem structures during aneurysm surgery.
- To analyze changes in somatosensory evoked potentials (SEPs) following papaverine administration.
Main Methods:
- Two patients undergoing craniotomy for aneurysm clipping received topical papaverine.
- Cortical somatosensory evoked potentials (SEPs) were monitored using median and tibial nerve stimulation.
- Hemodynamic parameters, arterial blood gases, and anesthetic levels were kept constant.
Main Results:
- Bilateral depression of cortical SEPs was observed after papaverine administration.
- These SEP changes occurred despite stable physiological parameters and successful aneurysm exclusion.
- Neurological function normalized within 1-2 hours post-extubation.
Conclusions:
- Topical papaverine may exert direct, transient effects on brainstem structures.
- The observed dysfunction was temporary, suggesting conservative management.
- Limiting papaverine spread to basal cisterns is advisable.
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