Cerebral Vasospasm: New Strategies in Research and Treatment
Vascular spasm, caused by subarachnoid hemorrhage, is an urgent problem of neurosurgery. In spite of regular international conferences on this topic, held since 1972, vasospasm remains “a dark castle, that is resistant to any attempts of having its doors cranked open”.
The IXth International Conference, devoted to cerebral vasospasm, was held in Istanbul in 2006. As a matter of fact, the present edition is a collection of reports, made by its participants.
The works are grouped in accordance with main topics of research:
Many articles are devoted to fundamental research on molecular and cellular levels. They throw light on biophysical and biochemical aspects of pathogenesis of this complication, caused by hemorrhage.
The results of clinical research are given in the section, describing vasospasm diagnosis with applying such modern modalities of visualization and estimation of cerebral circulation, as digital angiography, CT, MRI and transcranial Doppler.
В разделе, посвященном терапии вазоспазма в основном приведены результаты исследовании эффективности применения сернокислой магнезии и фасудила. Также приведены результаты клинических исследований клазозентена – нового ингибитора эндотелина. Несмотря на обильные авансы в адрес нового препарата результаты его испытаний не показали снижения летальности и инвалидизации.
The section, dealing with vasospasm therapy, describes results of research in efficacy of magnesium sulfate, fasudil and clasozentan, which is a new inhibitor of endothelin. Despite all enthusiasm, met by this drug, its trial has failed to demonstrate reduction of overall mortality and invalidism.
Vasospasm chemosurgery is a relatively new trend of subarachnoid hemorrhage treatment. Is goal is early lysis of blood clots in a subarachnoid space. It is achieved by intrathecal administration of fibrinolytic drugs, irrigation and drainage of basal cisterns and ventricles. According to data of pilot studies, lysis and drainage of clots reduces rates of spasm, brain infarction and unfavorable outcomes.
Considerable attention is paid to interventional methods of vasospasm treatment. In particular, it concerns balloon angioplasty and intra-arterial infusions of antispasmodics. It is generally adopted, that angioplasty is a more effective method of symptomatic vasospasm treatment. However, its use as a preventive measure is not justified.
The given information allows to come to the conclusion, that outcomes in cases with vasospasm are dependent not only on a complex of measures, aimed at correction of this complication proper, but also on multiple modalities, used for diagnosis and treatment of aneurysmatic disease as a whole. For example, tranexamic acid and CT-angiography, as well as optimization of spasm therapy make it possible to achieve a fourfold decrease of early repeated hemorrhages and a sevenfold reduction of mortality due to secondary neurological deficit, respectively.
Besides aneurysmatic hemorrhage, being a cause of spasm, traumatic vasospasm and vascular spasm, watched in pediatrics and street drugs abuse, are discussed in detail.
In conclusion it should be noted, that the present edition contains a rather great number of reports on vasospasm. Thus, it is a valuable source for researchers, working in this field, and a reliable reference book for trainees, interested in vascular neurosurgery.