Effectiveness of the head-shaking method combined with cisternal irrigation with urokinase in preventing cerebral vasospasm after subarachnoid hemorrhage

Shunsuke Kawamoto M.D., Ph.D. 1 , Kazuo Tsutsumi M.D., Ph.D. 1 , Gakushi Yoshikawa M.D. 1 , Mune-hisa Shinozaki M.D. 1 , Kyoko Yako M.D. 1 , Kazuya Nagata M.D., Ph.D. 1 , and Keisuke Ueki M.D., Ph.D. 1
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  • 1 Departments of Neurosurgery, Showa General Hospital and The University of Tokyo Hospital, Tokyo, Japan
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Object

The head-shaking method combined with cisternal irrigation has been proposed to be effective in preventing cerebral vasospasm after subarachnoid hemorrhage (SAH) by facilitating rapid washout of the clot from the subarachnoid space. This study was conducted to evaluate the effectiveness of this method.

Methods

The inclusion criteria included the following: 1) Fisher Grade 3 SAH on admission computerized tomography (CT) scans; 2) aneurysm secured within 48 hours of SAH onset; and 3) no focal deficit and ability to obey commands within 24 hours postsurgery. Two hundred thirty patients treated between 1994 and 2002 fulfilled the criteria. Because only one machine was available and it required 1 month of maintenance every other month, 114 patients underwent irrigation combined with the head-shaking method (head-shaking group), whereas the remaining 116 patients received cisternal irrigation alone (control group). There were no significant differences in sex, age, site of aneurysm, or preoperative grade between the two groups.

The incidence of symptomatic vasospasm with or without infarction, cerebral infarction on CT scans, and permanent ischemic neurological deficit was 25.7, 17.7, and 8.8%, respectively, in the control group and 15.2, 4.5, and 2.7% in the head-shaking group. The difference was statistically significant for symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit (p < 0.05). In a multivariate backward stepwise logistic regression analysis, absence of head shaking was the only variable that was predictive of permanent ischemic neurological deficit (p = 0.061). The outcomes evaluated using the modified Rankin Scale were better in the head-shaking group (p = 0.051).

Conclusions

The head-shaking method significantly reduced the incidence of symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit and improved the clinical outcomes in patients who underwent cisternal irrigation therapy after aneurysmal SAH.

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Contributor Notes

Address reprint requests to: Shunsuke Kawamoto, M.D., Ph.D., Department of Neurosurgery, Dokkyo University School of Medicine, 880 Mibu, Tochighi 321–0293, Japan. email: s-kawamt@dokkyomed.ac.jp.
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