Prevention of symptomatic vasospasm by topically applied nimodipine.

A 2.4 x 10(-5) M solution of the Calcium-antagonist Nimodipine was administered to the exposed cerebral vessels in 17 patients intraoperatively clipping of a ruptured aneurysm. The interval between subarachnoid haemorrhage and operation was 48 to 72 hours. The CT investigation had revealed blood accumulation in the basal cisterns in all cases. Vasodilatation was observed in all instances; the percentage being greater in small vessels as compared to large vessels. Postoperatively, a neurological deficit combined with angiographically verified vasospasm occurred in two patients, but was reversible in both. Fifteen patients remained free from symptomatic vasospasm and were discharged without neurological deficit. In 13 of these patients and 3 additional cases, a plastic cannula was placed intraoperatively so that postoperative topical administration of Nimodipine was possible. Postoperative control-angiograms after a mean interval of 7 days from SAH did not show severe spasm in any of the patients; localised moderate asymptomatic spasm was found in 8 cases and was reserved in 5. Moderate postoperative symptomatic spasm was observed in 2 patients, treated and reversed in one patient. In 5 of 7 cases without evidence of spasm in the angiogram postoperative topical administration of Nimodipine caused vasodilatation. It is concluded, that topical intracisternal administration of Nimodipine reverses intraoperative vascular spasm and decreases the probability of postoperative symptomatic vasospasm after early surgery.