[Preventive effect on intracranial arterial vasospasm using combined ventriculo-cisternal and cisternal drainage...

Cerebral vasospasm following subarachnoid hemorrhage (SAH) is one of the most important problems in the treatment of ruptured intracranial aneurysms. Several reports have recently emphasized that oxyHb from erythrocytes might be responsible for vasospasm. In this study, the hem-oxygenase which converts oxyHb to bilirubin was analyzed and the increase of hem-oxygenase in the CSF after SAH was reconfirmed. In 23 cases of ruptured intracranial aneurysms, combined ventriculo-cisternal drainage and cisternal drainage designed by us was performed after clipping of aneurysms in early stage after rupture. Through a Y-shaped tube the CSF accumulated in the cistern and was drained extracranially through cisternal drainage. As a result, 2 (9%) of the 23 patients treated with the drainage showed symptomatic vasospasm. On the other hand, 13 (33%) of 39 patients without the drainage showed symptomatic vasospasm. It may be concluded that the drainage may contribute to prevention of cerebral vasospasm after SAH.