Prevention of symptomatic vasospasm — effect of continuous cisternal irrigation with urokinase and ascorbic acid

Background. Continuous cisternal irrigation (CCI) with Urokinase (UK) and ascorbic acid (AsA) has been performed to prevent symptomatic vasospasm (SVS) after severe aneurysmal subarachnoid haemorrhage (SAH). To dissolve and wash out the SAH, CCI with urokinase is used. Ascorbic acid is added to degrade oxyhemoglobin, one of the strong Spasmogenic Substances. The efficacy and safety of this method were evaluated. Method. CCI with urokinase and ascorbic acid was performed consecutively in 336 patients who underwent acute surgery. The severity of SAH of the patients was classified as Fisher CT group 3, and the highest CT number exceeded 60 in the areas of SAH. After clipping the aneurysm, irrigation tubes were placed in the Sylvian fissure (inlet) and in the prepontine or chiasmatic cistern (outlet). Lactated Ringer Solution with urokinase (120 IU/ml) and ascorbic acid (4mg/ml) was infused at a rate of 30-60 ml/h. Findings. Of the 336 patients studied, SVS was observed in 15 cases (4.5%), and 8 of these 15 cases demonstrated sequela (2.4%). The average total blood Volume Calculated from the drained fluid was approximately 112 ml per patients. Analysis of the absorption spectrum of the drained fluid revealed the disappearance of the oxyhemoglobin specific 576nm peak. Irrigation related complications Occurred in 13 patients during the treatment; 2 patients experienced seizures; 4 patients developed meningitis; and 7 patients had intracranial haemorrhages. All of these patients fortunately recovered without neurological deficits. Conclusions. These results suggest that CCI with urokinase and ascorbic acid are effective in preventing SVS after severe aneurysmal SAH.