Clinical Study of Effect of Intrathecal Use of Alpha-tocopherol on Chronic Vasospasm Hirotoshi Sano, Motoi Shoda, Youko Kato, Kazuhiro Katada, Youichi
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1 Clinical Study of Effect of Intrathecal Use of Alpha-tocopherol on Chronic Vasospasm Hirotoshi Sano, Motoi Shoda, Youko Kato, Kazuhiro Katada, Youichi Shinomiya and Tetsuo Kanno Department of Neurosurgery, Fujita-Gakuen University, School of Medicine, Toyoake, Japan Summary Management for treatment of subarachnoid hemorrhage in acute stage is still controversial. One of the most important factors in the acute stage is chronic vasospasm. There are many different theories about the pathogenesis and treatment of chronic vasospasm. Recently we can prospect the occurrence of the symptomatic vasospasm by CT findings. Therefore we evaluate the effect of intrathecal use of alpha-tocopherol to prevent the symptomatic vasospasm on these cases. Alpha-tocopherol ( mg) were injected into subarachnoid space in 23 cases, including 15 cases with early operation and 8 cases with delayed operation. In cases with early operation, cisternal drainage was put into parachiasmatic cistern, and 100 mg of alpha-tocopherol was injected via the drainage tube every day for 2 weeks. In cases with delayed operation 100 mg of alpha-tocopherol was injected via spinal tap or ventricular drainage if CT revealed hydrocephalus. Occurrence of symptomatic vasospasm was evaluated in these 23 cases compared with that in cases without use of alpha-tocopherol as a control. Occurrence of symptomatic vasospasm in control group was 3% in gr 0, 7% in 1, 4% in gr 2, 45% in gr 4, 83% in gr 4. However, occurrence of symptomatic vasospasm in cases used alpha-tocopherol was 0% in gr 0 and 1, 11% in gr 2, 20% in gr 3, 40% in gr 4. Therefore, symptomatic vasospasm cccurred almost half in cases used alpha-tocopherol compared with control group.
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4 Table 2 Occurrence of the symptomatic vasospasm in the cases used vitamin E grade of hematoma in the basal cistern
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6 8) Liliequest, B., Lindquist, M. & Valdimarsson, E. : Computed tomography and subarachnoid hemorrhage. Neuroradiology, 14: 21-26, ) Miyaoka, M., Nonaka, T., Watanabe, H., Chigasaki, H. & Ishii, S.: of prolonged vasospasm-experimental Etiology and treatment and clinical 114, ) Mizukami, M., Kawase, T., Tazawa, T., Nagata, K., Yunoki, K. & Yoshida, Y.: Hypothesis and clinical evidence for the mechanism of chronic cerebral vasospasm after oubarachnoid hemorrhage Cerebral arterial spasm, proceedings of 2nd in ternat. workshop., 1979, pp ) Sano, H., Kanno, T., Shinomiya, Y., Katada, K., Katoh, Y. Nakagawa, T. & Adachi, K.: study. Neurol. Med. Chir., 16 (Part : 103- Prospection of chronic vasospasm by CT findings. Acta Neurochir., 63 : 23-30, ) Sano, H. & Kanno, T.: EC-IC bypass as a treatment for vasospasm after subarachnoid hemorrhage Cerebral Ischemia, Igakushoin, 1982, pp. 13) Sano, K. & Saito, I.: Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir., 41: 49-60, ) Sonobe, M. & Suzuki, J.: Vasospasmogenic substance produced following subarachnoid hemorrhage and its fate. II): 29-37, Neurol. Med. Chir., 18 (Part
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