Preventive effect of continuous cisternal irrigation with magnesium sulfate solution on angiographic cerebral vasospasms associated with aneurysmal subarachnoid hemorrhages: a randomized controlled trial.
Takuji Yamamoto MD, Kentaro Mori MD, Takanori Esaki MD, et al. (JNS)
In this single institution prospective randomized controlled study which was done in Japan, the investigators studied the efficacy of continuous direct infusion of MgSO4 solution into the intrathecal cistern in patients with an aneurysmal SAH after surgical clipping. This study included 70 consecutive patients presenting with SAH within 72 hours from ictus from April 2008 to March 2013. They had two groups, first one patients who received MgSO4 treatment protocol and the second control group of patients who did not receive MgSO4 treatment. They used transcranial Doppler (TCD) and cerebral angiography to evaluate the efficacy of intrathecal Mg infusion for preventing cerebral vasospasms (CV) and monitored both Mg2+ serum and Mg2+ CSF to assess the safety of this treatment. Also they used mRS after 3 months to assess the improvements in functional outcome. During clipping, the Liliequist membrane was opened to allow CSF circulation between the supratentorial and infratentorial compartments, and the cisternal drainage tube was placed into the basal cistern and a spinal drainage tube was also inserted. Continuous infusion of MgSO4 solution was performed at 20 ml/hr from day 4 until Day 14 through the cisternal to spinal drainage. A decline in consciousness and bradypnea possibly caused by the sedative effect of Mg were observed in Mg group. The TCD results indicated that velocity in MCA increased more in the control group. A delayed cerebral ischemia identified on CT or MRI scans was observed in 9 patients in the control group and in 5 patients in the Mg group. The clinical outcomes at the 3-month follow-up examination did not significantly differ in these outcomes. They concluded that continuous cisternal infusion with MgSO4 solution reduces the incidence of angiographic CV in patients with aneurysmal SAH, particularly of severe spasms on their angiographic CV scale. However this Mg treatment protocol did not reduce the incidence of delayed cerebral ischemia and did not improve clinical outcomes among the patients.
Abstract link: http://thejns.org/doi/abs/10.3171/2015.1.JNS142757?