Universität zu Köln

Albanna, Walid ORCID: 0000-0001-9986-8739, Weiss, Miriam ORCID: 0000-0001-8820-0805, Conzen, Catharina, Clusmann, Hans, Schneider, Toni, Reinsch, Martin, Mueller, Marguerite, Wiesmann, Martin, Hoellig, Anke and Schubert, Gerrit Alexander ORCID: 0000-0001-9135-6042 (2017). Systemic and Cerebral Concentration of Nimodipine During Established and Experimental Vasospasm Treatment. World Neurosurg., 102. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1878-8769

Full text not available from this repository.

Abstract

BACKGROUND: Oral nimodipine is an established prophylactic agent for cerebral vasospasm after subarachnoid hemorrhage (SAH). In highly selected cases, intra-arterial (IA) or intravenous (IV) application of nimodipine may be considered; however, the optimum dosage and modality of application remain a matter of debate. The purpose of this investigation is analysis of nimodipine concentration in serum, cerebrospinal fluid, and cerebral microdialysate in the context of currently effective dose and route of application (oral, IA, IV). METHODS:We prospectively collected 156 samples from 37 patients treated for aneurysmal SAH from May 2014 to July 2015. Treatment groups were stratified according to modality of application and low-dose or high-dose treatment. At time of sampling, current dose and modality of application effectively sustained cerebral perfusion as documented by common diagnostics. Samples were analyzed for nimodipine concentration via high-performance liquid chromatography and tandem mass spectrometry. RESULTS: In most cases (94.3%), nimodipine remained below the limit of quantification (0.5 ng/mL) within the brain (microdialysis, cerebrospinal fluid), even during targeted, local application (IA nimodipine). The median serum concentration for all treatment groups was 17.3 ng/mL. Modality of application (oral, IA, IV) was not associated with significant differences in serum concentrations (P = 0.712), even after stratification for dosage (P = 0.371), implying a comparable systemic distribution, if not efficacy. CONCLUSIONS: Nimodipine does not accumulate sufficiently within the target organ for treatment monitoring. Comparable systemic concentrations can be observed irrespective of application modality and dosing. Future studies will clarify the role of efficacy-driven treatment algorithms, in which lowest dose and least invasive mode of application still effective should be identified.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Albanna, Walid UNSPECIFIED orcid.org/0000-0001-9986-8739 UNSPECIFIED Weiss, Miriam UNSPECIFIED orcid.org/0000-0001-8820-0805 UNSPECIFIED Conzen, Catharina UNSPECIFIED UNSPECIFIED UNSPECIFIED Clusmann, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Toni UNSPECIFIED UNSPECIFIED UNSPECIFIED Reinsch, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Marguerite UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiesmann, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoellig, Anke UNSPECIFIED UNSPECIFIED UNSPECIFIED Schubert, Gerrit Alexander UNSPECIFIED orcid.org/0000-0001-9135-6042 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-228393
DOI:	10.1016/j.wneu.2017.03.062
Journal or Publication Title:	World Neurosurg.
Volume:	102
Date:	2017
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1878-8769
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANEURYSMAL SUBARACHNOID HEMORRHAGE; CONTINUOUS INTRAARTERIAL NIMODIPINE; INTRAVENOUS NIMODIPINE; ISCHEMIA Multiple languages Clinical Neurology; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22839