Effectiveness of the head-shaking method combined with cisternal irrigation with urokinase in preventing cerebral vasospasm after subarachnoid hemorrhage.
OBJECTIVE
The head-shaking method combined with cisternal irrigation has been proposed to be effective in preventing cerebral vasospasm after subarachnoid hemorrhage (SAH) by facilitating rapid washout of the clot from the subarachnoid space. This study was conducted to evaluate the effectiveness of this method.


METHODS
The inclusion criteria included the following: 1) Fisher Grade 3 SAH on admission computerized tomography (CT) scans; 2) aneurysm secured within 48 hours of SAH onset; and 3) no focal deficit and ability to obey commands within 24 hours postsurgery. Two hundred thirty patients treated between 1994 and 2002 fulfilled the criteria. Because only one machine was available and it required I month of maintenance every other month, 114 patients underwent irrigation combined with the head-shaking method (head-shaking group), whereas the remaining 116 patients received cisternal irrigation alone (control group). There were no significant differences in sex, age, site of aneurysm, or preoperative grade between the two groups. The incidence of symptomatic vasospasm with or without infarction, cerebral infarction on CT scans, and permanent ischemic neurological deficit was 25.7, 17.7, and 8.8%, respectively, in the control group and 15.2, 4.5, and 2.7% in the head-shaking group. The difference was statistically significant for symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit (p < 0.05). In a multivariate backward stepwise logistic regression analysis, absence of head shaking was the only variable that was predictive of permanent ischemic neurological deficit (p = 0.061). The outcomes evaluated using the modified Rankin Scale were better in the head-shaking group (p = 0.051).


CONCLUSIONS
The head-shaking method significantly reduced the incidence of symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit and improved the clinical outcomes in patients who underwent cisternal irrigation therapy after aneurysmal SAH.
Kawamoto
Shunsuke
S
Department of Neurosurgery, Showa General Hospital, The University of Tokyo Hospital, Tokyo, Japan. s-kawamt@dokkyomed.ac.jp
Tsutsumi
Kazuo
K
Yoshikawa
Gakushi
G
Shinozaki
Mune-hisa
MH
Yako
Kyoko
K
Nagata
Kazuya
K
Ueki
Keisuke
K
D000328:Adult; D000368:Aged; D002946:Cisterna Magna; D005260:Female; D006257:Head; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator