Post-operative cerebral vasospasm prophalaxis using hypertensive therapy alone in cerebral aneurysm clipping: Our experience at KIMS

Background: To discuss the institutional experience in the management of post operative vasospasm in cerebral aneurysms using hypertensive therapy. Materials and Methods: It is a retrospective descriptive study done in patients with cerebral aneurysms who were managed by surgery at KIMS hospital between Jan 2009 to Oct 2014. Totally 200 patients are included in this study. Results: As per the age distribution there were 39 patients with age < 40 yrs, 52 aged 40–49 yrs, 58 aged 50–59 yrs, 39 aged 60–69 yrs and 12 aged > 70 yrs. As per WFNS grading criteria 106 patients were Gr I, 52 were Gr II, 20 were Gr III, 17 were Gr IV and 5 were Gr V. 178 patient had ruptured aneurysm and 22 patient were with un-ruptured aneurysm. Of the 200 patients 61 patient developed post op vasospasm requiring treatment with Papaverine through intra-operatively placed reservoir. Of this 61 patients 10 patients had vasospasm during 1–2 days, 33 during 3–4 days, 13 during 5–10 days, 2 during 11–15 days 1 during 15–20 days and 2 patients developed vasospasm after 20 days post ictus respectively. Conclusions: Using only hypertensive therapy as prophylaxis for post op vasospasm 61 patients of the total 200 developed vasospasm, and 48 patients had vasospasm during 3^rd to 15^th day post ictus. To conclude the incidence of cerebral aneurysm is more common in females after 50 years. Most are ruptured status with WFNS Gr I. Prophylactic administration of Hypertensive therapy alone can decrease the incidence of post op vasospasm 30.5% in our study when compared to conventional use of triple H therapy where the incidence in various trials is in-conclusive.