Prevention of symptomatic vasospasm by continuous cisternal irrigation with mock-CSF containing ascorbic acid and Mg(2+).
BACKGROUND
Symptomatic vasospasm (SVS) is still a major cause of poor outcome in cases undergoing early surgical intervention for ruptured intracranial aneurysm. Among the numbers of therapeutic trials to prevent and ameliorate neurological deterioration due to SVS, removal or quenching of oxy-hemoglobin (OxyHb) from subarachnoid colts and administration of Mg(2+) (Mg) have especially been expected to be effective. In this report the authors investigated the effect of continuous cisternal irrigation (CCI) with mock CSF containing ascorbic acid (ASA) and Mg, performed after early surgery for ruptured aneurysm.


METHODS
Sixty-three cases which had received CCI were retrospectively compared with 40 control cases as to the incidence of SVS and outcome.


RESULTS
Incidence of SVS was significantly less frequent (P < 0.05) in the CCI group (11%) than in the control group (25%). Severe and definitive SVS requiring additional specific treatment occurred only in 3.2% of the CCI group, while 22.5% in the control (P < 0.01). Overall outcome at discharge was significantly better in the CCI group than in the control (P < 0.01).


CONCLUSIONS
Postoperative CCI with ASA and Mg was definitively effective in preventing SVS and in lessening severity of SVS if it occurs.
Satoh
Akira
A
Department of Neurosurgery, Stroke Center, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan. satohak@saitama-med.ac.jp
Sugiyama
Tatsuya
T
Ooigawa
Hidetoshi
H
Nakajima
Hiroyuki
H
Ogura
Takeshi
T
Neki
Hiroaki
H
Morikawa
Eiharu
E
D000368:Aged; D001205:Ascorbic Acid / Q000134:cerebrospinal fluid; D002946:Cisterna Magna; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008274:Magnesium / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D007507:Therapeutic Irrigation / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000134:cerebrospinal fluid / Q000209:etiology / Q000517:prevention & control
D008274:Magnesium; D001205:Ascorbic Acid