Surgical Procedure and Results of Cisternal Washing Therapy for the Prevention of Cerebral Vasospasm Following SAH

Abstract

In 1994, we started cisternal washing therapy (CWT) using urokinase combined with head-shaking method in order to prevent cerebral vasospasm. In this paper, we showed the surgical procedure for CWT and reported the effect of this therapy in preventing vasospasm following SAH. A total of 332 consecutive cases with Fisher group 3 SAH since 1988 were analyzed. Of these patients, 118 cases (56 cases before 1994 and 62 cases after 1994) had not CWT, and, 214 cases after 1994 had this therapy. All of these patients had clipping surgery within 3 days following SAH, and had postoperative management both with normovolemia and normal to mild hypertension. In these two groups, the incidence of symptomatic vasospasm (transiently symptomatic vasospasm without infarction), cerebral infarction due to vasospasm on CT, and mortality and morbidity (M&M) due to vasospasm were analyzed. In the group without CWT, the incidences of symptomatic vasospasm, cerebral infarction on CT, and M&M due to vasospasm were 4.2%, 28.8%, and 17.8%, respectively. On the other hand, in the group with CWT, they were 3.7%, 6.5%, and 2.8%, respectively. In the patients with CWT, the incidence of cerebral infarction on CT due to vasospasm and M&M due to vasospasm were significantly (p < 0.05) decreased. CWT was effective in preventing cerebral vasospasm.

Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage

“…This is in consensus with the retrospective and laboratory study of Riordan et al, 32 who found that mild exercise before the 4th day after aneurysm repair reduced symptomatic vasospasm from 55.2% to 13.6% without promoting neuronal injury. Frequent, systematic mobilization represents a form of kinetic treatment parallel to the "head-shaking method" 30,39 that was meant to help dissolve residual blood clots. The method is often used in conjunction with cisternal and ventricular lavage, 15 and there is strong evidence that it leads to a reduction in vasospasm and improves outcome.…”

“…The method is often used in conjunction with cisternal and ventricular lavage, 15 and there is strong evidence that it leads to a reduction in vasospasm and improves outcome. 15,22,30,39 Kawamoto et al 22 even concluded that "the effect of head shaking in preventing vasospasm is the most definite compared with any existing treatment protocol. "…”

“…New cerebral infarctions tended to occur less frequently in the early rehab group, an effect that was also described in head-shaking studies. 15,22,30 There was a trend for more patients with antecedent cardiac arrhythmia in the early rehab group, which could have made them more prone to arterial thromboembolic complications. The clinical relevance of this finding is uncertain.…”

Cerebral vasospasm: a review of current developments in drug therapy and research

“…A kinetic therapy using a head shaker or lateral rotational therapy in combination with local thrombolytic therapy has been described [7,136,137]. A recent analysis of three randomized studies, including a combination of thrombolytic and kinetic treatment, revealed a decrease in DCI, CVS and better clinical outcome in two studies [136,137].…”

New Developments in Drug Therapy and Research of Cerebral Vasospasm

“…As mentioned before, there is a strong rationale for interventions aimed at the clearance of subarachnoid blood. A kinetic therapy using a head shaker or lateral rotational therapy in combination with local thrombolytic therapy has been described [7,136,137]. A recent analysis of three randomized studies, including a combination of thrombolytic and kinetic treatment, revealed a decrease in DCI, CVS and better clinical outcome in two studies [136,137].…”