title: Transient pupillary dilation following local papaverine application in intracranial aneurysm surgery.
abstract: Isolated cases of transient pupillary changes after local intracisternal papaverine administration during aneurysm surgery have been reported. This study aimed to determine the prevalence and factors associated with this phenomenon. We assessed a total of 103 consecutive patients who underwent craniotomy for cerebral aneurysm clipping for the presence of postoperative pupillary dilation (mydriasis) after intracisternal papaverine administration. Univariate and multivariate logistic regression were conducted to evaluate the association of mydriasis with patient age, sex, duration of surgery, and aneurysm location. We observed either ipsilateral or bilateral pupillary dilation in the immediate postoperative period in nine out of 103 patients (8.7%). This phenomenon was not associated with patient age or sex. There was a trend towards positive correlation with aneurysms located at the anterior communicating artery (odds ratio 3.76, p=0.10), and a negative correlation with the duration of surgery (odds ratio 0.57, p=0.08). All pupillary dilation resolved within several hours, and the onset and resolution were consistent with the half-life of papaverine. To our knowledge, this represents the largest study of posteropative pupillary changes due to papaverine. The current findings are consistent with the small number of prior case reports of transient pupillary changes after papaverine administration and appear to reflect the local anesthetic action of papaverine on the oculomotor nerve.
authors.affiliation: Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Viren
authors.initials: V
authors.lastname: Vasudeva
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Pui Man Rosalind
authors.initials: PM
authors.lastname: Lai
authors.affiliation: Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Carle Foundation Hospital, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL, USA.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: rdu@partners.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020771:Anterior Cerebral Artery / Q000473:pathology; D003399:Craniotomy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015878:Mydriasis / Q000139:chemically induced*; D019635:Neurosurgical Procedures / Q000379:methods*; D009802:Oculomotor Nerve / Q000187:drug effects; D010208:Papaverine / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000517:prevention & control; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine
keywords: Drug effects; Intracranial aneurysm; Mydriasis; Papaverine; Pupil dilation