Brain monoamine metabolites and tryptophan in ventricular CSF of patients with spasm after aneurysm surgery

Abstract

✓ Intraventricular pressure was followed continuously after operation for intracranial arterial aneurysm in 20 patients. Ventricular cerebrospinal fluid (CSF), homovanillic acid (HVA), tryptophan, and 5-hydroxyindole acetic acid (5-HIAA) were analyzed daily for 5 days, beginning before the clipping of the aneurysm. Postoperatively, seven patients had spasm, verified clinically and angiographically. Seven other patients with no clinical or angiographic signs of spasm, hydrocephalus, or increased intracranial pressure (ICP) served as controls. Nine of the 20 patients were hydrocephalic. The mean ± SE values of HVA, tryptophan, and 5-HIAA in the controls were 264 ± 40, 1116 ± 85, and 88 ± 8 ng/ml, respectively, in the controls, and 182 ± 20, 982 ± 89, and 78 ± 3 ng/ml, respectively, in the patients with spasm. The differences are not statistically significant. However, the low values of HVA may have been produced by ischemic changes caused by the spasm. In hydrocephalic patients ventricular CSF tryptophan levels were statistically significantly higher, and 5-HIAA levels lower than in controls. In patients with increased ICP, neither alterations nor intercorrelations of monoamine metabolites and tryptophan were found. The results do not give direct support to prophylactic neuropharmacological treatment of postoperative arterial cerebral spasm. However, ventricular HVA, tryptophan, and 5-HIAA measurements can be used for prognostic purposes during the first few days after the operation.

Tryptophan metabolism via serotonin in human CSF of different brain sites using a new neuroendoscopic technique

“…Any significant change was observed in the values of 5-HTP among the three sites of CSF sampling: 5-HT was not detectable in the control CSF, whereas it was present in the right ventricular CSF of hydrocephalic patients. Instead, a clear gradient of concentration is present for 5-HIAA among ventricular, cisternal, and lumbar CSF both in the control group, in agreement with many authors [15,20,[22][23][24][25][26][27][28][29][30][31][32][33][34], and in patients with non-communicating hydrocephalus. This gradient may depend on the concentration in the nervous tissues and on the rate of CSF flow and of removal from CSF [15,[35][36][37].…”

Study of tryptophan metabolism via serotonin in cerebrospinal fluid of patients with noncommunicating hydrocephalus using a new endoscopic technique

“…The present data demonstrate that a clear gradient of concentration exists for 5‐HIAA among ventricular, cisternal, and lumbar CSF either in controls, in agreement with many authors (Ashcroft and Sharman, 1960; Andersson and Roos, 1967; Gerbode and Bowers, 1968; Moir et al, 1970, Gordon and Oliver, 1971; West et al, 1972; Chase et al, 1973; Johansson and Roos, 1975; Young et al, 1973; Sourkes et al, 1975; Massarotti et al, 1974, 1975a,b, 1976, 1978, 1980; Curzon et al, 1976, Valpalahti et al, 1978), and in patients with noncommunicating hydrocephalus. The gradient we observed for 5‐HIAA in CSF, with higher levels in the cisternal than in lumbar CSF, has been reported also in the literature (Forn, 1972; Garelis et al, 1974).…”

Subarachnoid haemorrhage in the rat: effect on the development of cerebral vasospasm of lesions in the central serotoninergic and dopaminergic systems.

“…10 Further, measurements of CSF concentrations of 5-HT or its metabolite 5-hydroxyindole acetic acid from patients with a SAH have demonstrated levels similar to control values. 28 into the cisterns or subarachnoid space of unphysiological, large amounts of 5-HT only produced a moderate and shortlasting spasm. 9 -27 It is interesting that Tagari et al recently have found a 5-HT like vasoconstrictor activity in CSF collected peroperatively from SAH patients.…”