Surgical procedure and results of cisternal washing therapy for the prevention of cerebral vasospasm following SAH.
In 1994, we started cisternal washing therapy (CWT) using urokinase combined with head-shaking method in order to prevent cerebral vasospasm. In this paper, we showed the surgical procedure for CWT and reported the effect of this therapy in preventing vasospasm following SAH. A total of 332 consecutive cases with Fisher group 3 SAH since 1988 were analyzed. Of these patients, 118 cases (56 cases before 1994 and 62 cases after 1994) had not CWT, and, 214 cases after 1994 had this therapy. All of these patients had clipping surgery within 3 days following SAH, and had postoperative management both with normovolemia and normal to mild hypertension. In these two groups, the incidence of symptomatic vasospasm (transiently symptomatic vasospasm without infarction), cerebral infarction due to vasospasm on CT, and mortality and morbidity (M&M) due to vasospasm were analyzed. In the group without CWT, the incidences of symptomatic vasospasm, cerebral infarction on CT, and M&M due to vasospasm were 4.2%, 28.8%, and 17.8%, respectively. On the other hand, in the group with CWT, they were 3.7%, 6.5%, and 2.8%, respectively. In the patients with CWT, the incidence of cerebral infarction on CT due to vasospasm and M&M due to vasospasm were significantly (p < 0.05) decreased. CWT was effective in preventing cerebral vasospasm.
Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi City, Tokyo, 173-8605, Japan. nsnaka@med.teikyo-u.ac.jp
Tadayoshi
T
Nakagomi
Kazuhide
K
Furuya
Hiroshi
H
Nagashima
Jun-Ichi
J
Tanaka
Teruyuki
T
Ishii
Shigehiko
S
Takanashi
Takeyuki
T
Shinohara
Fumihiro
F
Watanabe
Akiko
A
Ogawa
Norio
N
Fujii
Akira
A
Tamura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002946:Cisterna Magna / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D007507:Therapeutic Irrigation / Q000379:methods; D015898:Tomography Scanners, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
D014568:Urokinase-Type Plasminogen Activator