Spinal cord stimulation for cerebral vasospasm as prophylaxis.
Cervical spinal cord stimulation (SCS) was used to increase cerebral blood flow (CBF) in 10 patients with secured cerebral aneurysms in Hunt and Hess grade 3 or 4 and with Fisher group 3 subarachnoid hemorrhage (SAH). The patients underwent preemptive electrical stimulation through a percutaneous lead following aneurysm surgery. All patients also received hypervolemic therapy and nicardipine. Efficacy of the treatment was evaluated using xenon computed tomography and cerebral angiography. The CBF in the distribution of the middle cerebral artery significantly increased following SCS (p < 0.05). Four of 10 patients showed angiographic vasospasm, but none developed severe sequelae of cerebral vasospasm. The overall outcome was good or excellent in seven of the 10 patients. No serious adverse effects due to SCS were observed. Fluid management and calcium antagonist have a beneficial effect on cerebral vasospasm following SAH, but is not tolerated or is ineffective in some patients. SCS as an adjunctive therapy for cerebral vasospasm following SAH may have a favorable effect on outcome.
Division of Neurosurgery, Hiratsuka Kyousai Hospital, Kanagawa.
Y
Y
Takanashi
M
M
Shinonaga
D000368:Aged; D001921:Brain / Q000098:blood supply; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D012039:Regional Blood Flow / Q000502:physiology; D013116:Spinal Cord / Q000503:physiopathology*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000503:physiopathology / Q000517:prevention & control*