Cerebral Vasospasm – A serious obstacle in a successful aneurysm surgery

Open access


Background: Cerebral vasospasm that occurs after subarachnoid hemorrhage (SAH) can be an important cause of mortality and morbidity for patients successfully operated for a cerebral aneurysm.

Methods: Five cases of prompt diagnostic and surgical treatment of a cerebral aneurysm, with important SAH on cerebral computed tomography (CT) at onset, are presented. All patients were admitted in a poor neurological state and developed severe vasospasm. Both, the correct clipping of the aneurysm and the cerebral vasospasm were angiographic demonstrated in all cases. Two patients showed complete obliteration of one carotid artery.

Results: Postoperatory, four of the patients were treated with intrathecally administered nimodipine (10mg/50ml). In three cases, the procedure caused the reverse of the vasospasm and clinical improvement of the patients. Their clinical outcomes were very good and were discharged with minimal neurological deficits. In one case, repeated intraarterial administration of nimodipine, showed no reduction of the vasospasm, and no improvement of patient’s clinical status. The patient was conscious, but presented focal neurological deficits (hemiplegia and aphasia). One patient did not benefit from this treatment and had a poor clinical outcome, remaining in a vegetative state.

Conclusions: Cerebral vasoconstriction after SAH could be an important obstacle in obtaining very good results in aneurysm surgery. Intra-arterial administration of nimodipine is an important and useful treatment, but good results in reversal severe cerebral vasospasm are not always mandatory.

1. Bailes JE, Spetzler JF, Hadley MN, Baldwin HZ (1990). Management and morbidity of poor-grade aneurysm patients. J Neurosurg 72:559-566.

2. Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A (1994). Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke 25: 1342-1347.

3. Davis JM, Davis KR, Crowell RM (1980).

Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm: Prognostic significance of cranial CT. AJNR Am J Neuroradiol 1:17-21.

4. Dorsch NWC, King MT (1994). A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage: I.

Incidence and effects. J Clin Neuroscience 1:19-26.

5. Ecker A, Riemenschneider PA (1951). Arteriographic demonstration of spasm of the intracranial arteries: With special reference to saccular arterial aneurysm. J Neurosurg 8:660-667, 1951.

6. Eskridge JM, McAuliffe W, Song JK, Deliganis AV, Newell DW, Lewis DH, Mayberg MR, Winn HR (1998). Balloon angioplasty for the treatment of vasospasm: Results of first 50 cases. Neurosurgery 42:510-517.

7. Findley J.M. (2004). Cerebral Vasospasm. In H.

Richard Winn (Eds). Youmans Neurological Surgery Fifth Ed. (pp. 1839-1867). Philadelphia, Pennsylvania: Saunders Elsevier. ISBN 0-7216-8291-x.

8.Findlay JM, Deagle JM (1998). Causes of morbidity and mortality following intracranial aneurysm rupture.

Can J Neurol Sci 25:209-215.

9. Findlay JM, Kassell NF, Weir BKA, Disney LB, Grace MGA (1995). A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm.

Neurosurgery 37:168-178.

10. Fischer CM, Kistler JP, Davis JM (1980). Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning.

Neurosurgery 6:1-9.

11. Greenberg MS (2006). Handbook of Neurosurgery, Sixth Ed. Lakeland, Florida. Thieme Medical Publishers New York, NY.

12. Heros RC, Zervas NT, Varsos V (1983). Cerebral vasospasm after subarachnoid hemorrhage: An update.

Ann Neurol 14:599-608.

13. Mee E, Dorrance D, Lowe D, Neil-Dwyer G (1988). Controlled study of nimodipine in aneurysm patients treated early after subarachnoid hemorrhage.

Neurosurgery 22:484-491.

14. Nakagomi T, Kassell NF, Hongo K, Sasaki T (1990). Pharmacological reversibility of experimental cerebral vasospasm. Neurosurgery 27:582-586.

15. Philippon J, Grob R, Dagreou F, Guggiari M, Rivierez M, Viars P (1986). Prevention of vasospasm in subarachnoid hemorrhage: A controlled study with nimodipine. Acta Neurochir 82:110-114.

16. Pickard JD, Murray GD, Illingworth R, Shaw MD, Teasdale GM, Foy PM (1989). Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage: British aneurysm nimodipine trial. BMJ 298:636-642.

17. Qureshi AI, Sung GY, Razumovsky AY, Lane K, Straw RN, Ulatowski JA (2000). Early identification of patients at risk for symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. Crit Care Med 28:948-990.

18. Qureshi AI, Sung GY, Suri MAK, Straw RN, Guterman LR, Hopkins LN (1999). Prognostic value and determinants of ultra-early angiographic vasospasm after aneurysmal subarachnoid hemorrhage.

Neurosurgery 44:967-974.

19. Rabb CH, Tang G, Chin LS, Giannotta SL (1994).

A statistical analysis of factors related to symptomatic cerebral vasospasm. Acta Neurochir (Wien) 127:27-31.

20. Ropper AH, Zervas NT (1984). Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality and functional status in 112 consecutive good-risk patients. J Neurosurg 60:909-915.

21. Sano H, Kanno T, Shinomya Y. (1982). Prospection of chronic vasospasm by CT findings. Acta Neurochir (Wien) 63:23-30.

22. Zambraski J.M., Hamilton M.G (2000). Cerebral Vasospasm. In Carter LP α Spetzler RF (Eds).

Neurovascular Surgery (pp. 583-600). McGraw-Hill, Inc.

Romanian Neurosurgery

The Journal of Romanian Society of Neurosurgery

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 127 75 9
PDF Downloads 56 44 6