Prevention of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage by intraoperative cisternal fibrinolysis using tissue-type plasminogen activator combined with continuous cisternal drainage

Hiroyuki Kinouchi, Kuniaki Ogasawara, Hiroaki Shimizu, Kazuo Mizoi, Takashi Yoshimoto

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

The efficacy of intraoperative cisternal irrigation using tissue-type plasminogen activator (tPA) combined with continuous cisternal drainage was assessed for the prevention of symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Seventy consecutive patients underwent direct surgery for aneurysm clipping within 48 hours of SAH and had computed tomography (CT) findings classified as Fisher group III or IV with densities of more than 65 Hounsfield units (HU). Fibrinolysis of the cisternal clots was performed during surgery using 1.8 mg tPA in 55 cases or 3.2 mg tPA in 15 cases. If postoperative CT within 24 hours of surgery showed areas with density more than 65 HU, additional tPA (0.8 mg/day) was administered into the cisternal catheter until the high density areas disappeared. The cisternal drainage catheters were left in place until day 14. Additional tPA injection was necessary in four of the 55 patients receiving 1.6 mg tPA. Symptomatic vasospasm occurred in three patients (4.3%) and two patients had low density areas on CT. Permanent deficit (hemiparesis) due to cerebral vasospasm remained in only one patient. Intraoperative cisternal irrigation with tPA combined with cisternal drainage is safe and effective for the prevention of symptomatic vasospasm following SAH.

Original languageEnglish
Pages (from-to)569-575
Number of pages7
JournalNeurologia medico-chirurgica
Volume44
Issue number11
DOIs
Publication statusPublished - 2004 Nov

Keywords

  • Aneurysm
  • Cisternal drainage
  • Fibrinolysis
  • Subarachnoid hemorrhage
  • Tissue-type plasminogen activator
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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