Cisternal washing therapy for the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Cerebral vasospasm is still one of the major causes of mortality and morbidity (M & M) in patients with subarachnoid hemorrhage (SAH) [1]. In spite of intense and extensive investigation over the past four decades, the optimal treatment of cerebral vasospasm has not yet been established. Clinical studies have clearly demonstrated the relationship between the location and volume of the subarachnoid clots and the incidence, distribution, and severity of vasospasm [3, 4, 11]. In 1988, Kodama et al. reported that cisternal irrigation therapy with urokinase and ascorbic acid was effective in preventing cerebral vasospasm [5]. In 1990, Suzuki et al. demonstrated that head-shaking method enhanced the fibrinolysis in cisternal irrigation [10]. In January 1994, we combined these two methods in order to achieve better outcome in Fisher CT group 3 patients and started cisternal irrigation therapy with urokinase combined with head-shaking, i.e., cisternal washing therapy. In this paper, we retrospectively analyzed 250 consecutive cases with SAH, who had clipping surgery within 3 days following SAH, and investigated the effect of this fibrinolytic therapy in preventing symptomatic vasospasm.