Intraventricular Nicardipine for Cerebral Vasospasm in Children: A Case Series

Treatment of cerebral vasospasm in children is challenging because administration of intravenous calcium channel blockers can cause systemic hypotension and worsened cerebral perfusion. Intraventricular nicardipine has been used as an alternative modality for treating vasospasm in adult subarachnoid hemorrhage populations. The literature describing intraventricular calcium channel blocker therapy for pediatric cerebral vasospasm is sparse. The goal of this study was to perform a descriptive, retrospective chart review of all children at our institution who received intraventricular nicardipine for the prevention of or treatment of cerebral vasospasm.

We queried the electronic medical record of our institution for all inpatients who had been prescribed intraventricular nicardipine from January 1, 2006, to December 31, 2023. Patients' charts were manually examined for relevant clinical information. Standard descriptive statistics were used to summarize the case series data.

We identified 11 patients who had received intraventricular nicardipine via an external ventricular drain. Most children were adolescents (10-17 years old), and most patients (8/11; 73%) had a ruptured intracranial aneurysm as the cause of their subarachnoid hemorrhage. All patients survived with median Functional Status Scores of 6 at discharge, indicating normal function with no deficits.

In our limited retrospective series of patients, intraventricular administration of nicardipine appears to be a safe alternative modality for management of cerebral vasospasm. Larger, multicenter, prospective pediatric studies are needed to more precisely define treatment indications, define regimens, and improve outcomes.