Prolonged Intracisternal Papaverine Toxicity: Index Case Description and Proposed Mechanism of Action

Zhou, Xiaofei; Alambyan, Vilakshan; Ostergard, Thomas; Pace, Jonathan; Kohen, Maryo Cenk; Manjila, Sunil; Ramos-Estébanez, Ciro

doi:10.1016/j.wneu.2017.09.196

Cited by 7 publications

(4 citation statements)

References 60 publications

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“…This literature review showed that intracisternal papaverine can cause ipsilateral (6,9,(11)(12)(13)18), contralateral (6,7,21), and even bilateral oculomotor nerve palsy (7)(8)(9)(10)19). The ipsilateral oculomotor palsy in the form of mydriasis with a non-reacting pupil was the most common reported complication of intracisternal papaverine installation (18 out of 43 patients).…”

Section: Resultsmentioning

confidence: 96%

“…The oculomotor-related complications usually resolved within the first day with the majority of patients recovering within the first 5 hours. However, in three cases the resolution extended beyond 4-7 days and even up to 23 days in one report (8,10,12). As compared to cranial nerve paresis, the hemodynamic complications of intracisternal papaverine were more abrupt with the majority of reports charting a resolution time of few minutes; only two cases, that reported hypotension, recorded a resolution time of more than one hour (20,22).…”

Section: Resultsmentioning

confidence: 99%

“…Our search yielded 19 articles, with a total of 43 aneurysms. As for the types of articles; there were two original articles (5,6), two case reports and reviews (7,8), one case series (9), nine case reports (10)(11)(12)(13)(14)(15)(16)(17)(18), and five letters to the editor (19)(20)(21)(22)(23). The two most common aneurysm locations that were associated with topical papaverine complications were the middle cerebral artery (MCA) and the anterior communicating artery (AcomA) with 18 and 17 cases, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Al-Sharshahi¹,

Hoz²,

Almurayati³

et al. 2020

roneuro

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Introduction. Cerebral vasospasm is a major cause of mortality in patients with subarachnoid haemorrhage. Irrigation of intracisternal papaverine has been adopted as a strategy to reduce the incidence of aneurysm-surgery-associated vasospasm. Aim. The aim of this literature review is to summarize the reported complications associated with intracisternal papaverine administration. Patients and Methods. We searched the following databases: PubMed, Google Scholar, Cochrane Library, Clinical Key, Embase, Emerald, Health Business Elite, MEDLINE at OVID, EBM Reviews and Research Gate. The following keywords were used: Intracisternal papaverine, topical papaverine, direct papaverine, a vasodilator for aneurysm surgery, papaverine in aneurysm clipping, papaverine complications and papaverine side effects. The search criteria included all articles published between 1980-2019, in the English language. Results. Our search yielded a total of 19 articles describing 43 cases. The most common reported complication was ipsilateral oculomotor nerve palsy. Other local complications included: Bilateral oculomotor nerve palsy, ipsilateral facial nerve palsy, and monocular blindness. Although less common, reports pointing to papaverine systemic toxicity did exist. Examples of such complications included: Profound hypotension, bradycardia, hypertension and tachycardia, hyperthermia and metabolic acidosis, cardiac arrest and even death. Conclusion. Intracisternal papaverine irrigation is an effective strategy in reducing peri-operative vasospasm associated with aneurysm surgery. Although uncommon, both local and systemic side effects have been linked to papaverine use, calling for careful dosing and close monitoring to enhance its safety profile.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Al-Sharshahi¹,

Hoz²,

Almurayati³

et al. 2020

roneuro

View full text Add to dashboard Cite

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“…Drug-related pupil dilation is also a common factor, and numerous drugs can disrupt the balance of the sympatheticsystem, influencing pupil size to varying degrees. Sympathetic-activated medicines, such as adrenalin, norepinephrine, and ephedrine, can excite the sympathetic nervous system, directly leading to mydriasis 9 ; atropine, scopolamine, and ipratropium can antagonize the function of the vagus nerve to induce dilation of pupils [14][15][16][17] ; papaverine, as an opioid derivative, is mainly used to resist against vasospasm in clinic, whereas Zhou et al 18 reported that its toxic and side effects could also lead to transient dilatation of pupils; studies demonstrated that anesthetics, such as propofol and rocuronium, may also cause dilation of pupils in some patients 19,20 ; for instance, in 2017, Korf et al 21 reported a case of transient dilated pupils caused by inhalation of the sevoflurane. Sevoflurane, propofol, and rocuronium were all used in both cases.…”

Section: Anestheticsmentioning

confidence: 99%

Bilateral Transient Dilated and Fixed Pupils After Microvascular Decompression: Rare Clinical Experience

Wang

Fan

et al. 2023

Journal of Craniofacial Surgery

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Microvascular decompression (MVD) has a satisfactory safety, and it is the only surgical treatment for neurovascular compression diseases, such as hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia, from the perspective of etiology. Bilateral dilated and fixed pupils have long been regarded as a sign of life threatening, which is common in patients with cerebral herniation due to cranial hypertension. However, transient dilated pupils after MVD have not been previously reported. Here, we presented 2 patients with bilateral transient dilated and fixed pupils after MVD and discussed the possible etiologies through the literature review. Physical examination of both patients showed bilateral pupils were normal and without a medical history of pupil dilation. They underwent MVD under general anesthesia and used propofol and sevoflurane. In both cases, the vertebral artery was displaced, and Teflon pads were inserted between the vertebral artery and the brain stem. Postoperation, we found transient bilateral mydriasis without light reflection in both patients. The emergency head computed tomography revealed no obvious signs of hemorrhage and cerebral herniation. About 1 hour later, this phenomenon disappeared. Therefore, the authors think if MVD is successfully carried out, bilateral transient mydriasis may not necessarily indicate brain stem hemorrhage, cerebral herniation, and other emergency conditions, which can be recovered within a short time. The causes could be related to stimulation of the sympathetic pathway in the brain stem during MVD and side effects of anesthetics.

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Diluted Papaverine for Microvascular Protection of Cranial Nerves

Campione

Scavo

Cacciotti

et al. 2019

Advances in Vestibular Schwannoma Microneurosurgery

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Prolonged Intracisternal Papaverine Toxicity: Index Case Description and Proposed Mechanism of Action

Cited by 7 publications

References 60 publications

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Bilateral Transient Dilated and Fixed Pupils After Microvascular Decompression: Rare Clinical Experience

Diluted Papaverine for Microvascular Protection of Cranial Nerves

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