Intraoperative topical nimodipine after aneurysm clipping

Area of Science:

• Neurosurgery
• Pharmacology
• Vascular Medicine

Background:

• Subarachnoid hemorrhage from ruptured intracranial aneurysms frequently causes cerebral vasospasm.
• Cerebral vasospasm can lead to ischemic complications and poor neurological outcomes.
• Nimodipine is a lipophilic calcium antagonist with known vasodilatory properties.

Purpose of the Study:

• To evaluate the efficacy of intraoperative subarachnoid Nimodipine administration in treating cerebral vasospasm during aneurysm surgery.
• To assess the potential of Nimodipine to prevent postoperative ischemic complications.

Main Methods:

• Nimodipine solution (2.4 X 10(-5) M in Ringer's) was administered into the subarachnoid space post-aneurysm clipping in 40 patients.
• Angiographic and clinical outcomes were monitored.
• Comparison with papaverine's vasodilatory capacity was considered based on prior experimental data.

Main Results:

• Intraoperative administration of Nimodipine resulted in regular arterial dilation.
• Spastic arterial segments resumed normal diameters following Nimodipine injection.
• Nimodipine demonstrated a strong dilator capacity, acting for several hours.

Conclusions:

• Intraoperative Nimodipine effectively reverses vasospasm, removing it as a contraindication for early aneurysm surgery.
• The long-lasting effect of Nimodipine may prevent early postoperative ischemic complications.
• Nimodipine appears protective against severe symptomatic vasospasm post-operatively.