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Advances in Vestibular Schwannoma Microneurosurgery pp 123–130Cite as

Diluted Papaverine for Microvascular Protection of Cranial Nerves

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Abstract

Silent cerebral vasospasm following surgical resection of vestibular schwannomas is much more common than previously thought. This might mean that the cerebral circulation shows a high reactivity to surgical trauma, and it can be hypothesized that this happens not only in elastic and muscular arteries but also in arterioles—and especially those within the cerebellopontine angle. From this perspective, prevention of vasospasm is useful for microvascular protection of the cranial nerves. Papaverine is known to be a potent vasodilator directly acting on smooth muscle and causing it to relax. Intra-arterial administration of papaverine has been used to treat arterial vasospasm after aneurysmal subarachnoid hemorrhage. When applied topically, it acts as a smooth muscle relaxant to break intraoperative vasospasm. The most important side effects of topical papaverine in vestibular schwannoma surgery are transient palsies of facial and cochlear nerves. It has been proposed that intracisternal papaverine at a concentration of 0.3% would be reasonably safe.

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References

  1. Aoki N, Origitano TC, al-Mefty O. Vasospasm after resection of skull base tumors. Acta Neurochir. 1995;132(1–3):53–8.

    Article  CAS  Google Scholar 

  2. Bejjani GK, Sekhar LN, Yost AM, Bank WO, Wright DC. Vasospasm after cranial base tumor resection: pathogenesis, diagnosis, and therapy. Surg Neurol. 1999;52(6):577–83; discussion 83–4.

    Article  CAS  Google Scholar 

  3. Krayenbuhl H. [Not available]. Schweiz Med Wochenschr 1959;89(8):191–5.

    Google Scholar 

  4. Krayenbühl H. Beitrag zur Frage des cerebralen angiopastischen Insults. Schweiz Med Wochenschr. 1960;90:961–5.

    Google Scholar 

  5. de Almeida GM, Bianco E, Souza AS. Vasospasm after acoustic neuroma removal. Surg Neurol. 1985;23(1):38–40.

    Article  Google Scholar 

  6. Kania R, Lot G, Herman P, Tran Ba Huy P. [Vascular complications after acoustic neurinoma surgery]. Ann Otolaryngol Chir Cervicofac 2003;120(2):94–102.

    Google Scholar 

  7. Qi J, Jia W, Zhang L, Zhang J, Wu Z. Risk factors for postoperative cerebral vasospasm after surgical resection of acoustic neuroma. World Neurosurg. 2015;84(6):1686–90.

    Article  Google Scholar 

  8. Mom T, Montalban A, Khalil T, Gabrillargues J, Chazal J, Gilain L, et al. Vasospasm of labyrinthine artery in cerebellopontine angle surgery: evidence brought by distortion-product otoacoustic emissions. Eur Arch Otorhinolaryngol. 2014;271(10):2627–35.

    Article  Google Scholar 

  9. Morawski K, Telischi FF, Merchant F, Namyslowski G, Lisowska G, Lonsbury-Martin BL. Preventing internal auditory artery vasospasm using topical papaverine: an animal study. Otol Neurotol. 2003;24(6):918–26.

    Article  Google Scholar 

  10. Cooper GJ, Wilkinson GA, Angelini GD. Overcoming perioperative spasm of the internal mammary artery: which is the best vasodilator? J Thorac Cardiovasc Surg. 1992;104(2):465–8.

    Article  CAS  Google Scholar 

  11. Newell DW, Elliott JP, Eskridge JM, Winn HR. Endovascular therapy for aneurysmal vasospasm. Crit Care Clin. 1999;15(4):685–99, v.

    Article  CAS  Google Scholar 

  12. Yu JT, Patel AJ, Malata CM. The use of topical vasodilators in microvascular surgery. J Plast Reconstr Aesthet Surg. 2011;64(2):226–8.

    Article  Google Scholar 

  13. Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS. Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg. 1992;77(6):848–52.

    Article  CAS  Google Scholar 

  14. Gao YJ, Stead S, Lee RM. Papaverine induces apoptosis in vascular endothelial and smooth muscle cells. Life Sci. 2002;70(22):2675–85.

    Article  CAS  Google Scholar 

  15. Kerschner JE, Futran ND. The effect of topical vasodilating agents on microvascular vessel diameter in the rat model. Laryngoscope. 1996;106(11):1429–33.

    Article  CAS  Google Scholar 

  16. Ricci JA, Koolen PG, Shah J, Tobias AM, Lee BT, Lin SJ. Comparing the outcomes of different agents to treat vasospasm at microsurgical anastomosis during the papaverine shortage. Plast Reconstr Surg. 2016;138(3):401e–8e.

    Article  CAS  Google Scholar 

  17. Rinkinen J, Halvorson EG. Topical vasodilators in microsurgery: what is the evidence? J Reconstr Microsurg. 2017;33(1):1–7.

    Article  Google Scholar 

  18. Vargas CR, Iorio ML, Lee BT. A systematic review of topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery. Plast Reconstr Surg. 2015;136(2):411–22.

    Article  CAS  Google Scholar 

  19. Dalbasti T, Karabiyikoglu M, Ozdamar N, Oktar N, Cagli S. Efficacy of controlled-release papaverine pellets in preventing symptomatic cerebral vasospasm. J Neurosurg. 2001;95(1):44–50.

    Article  CAS  Google Scholar 

  20. Pennings FA, Albrecht KW, Muizelaar JP, Schuurman PR, Bouma GJ. Abnormal responses of the human cerebral microcirculation to papaverin during aneurysm surgery. Stroke. 2009;40(1):317–20.

    Article  CAS  Google Scholar 

  21. Praeger AJ, Lewis PM, Hwang PY. Topical papaverine as rescue therapy for vasospasm complicated by unsecured aneurysm. Ann Acad Med Singap. 2014;43(1):62–3.

    PubMed  Google Scholar 

  22. Swartz WM, Brink RR, Buncke HJ. Prevention of thrombosis in arterial and venous microanastomoses by using topical agents. Plast Reconstr Surg. 1976;58(4):478–81.

    Article  CAS  Google Scholar 

  23. Hou SM, Seaber AV, Urbaniak JR. Relief of blood-induced arterial vasospasm by pharmacologic solutions. J Reconstr Microsurg. 1987;3(2):147–51.

    Article  CAS  Google Scholar 

  24. Evans GR, Gherardini G, Gürlek A, Langstein H, Joly GA, Cromeens DM, et al. Drug-induced vasodilation in an in vitro and in vivo study: the effects of nicardipine, papaverine, and lidocaine on the rabbit carotid artery. Plast Reconstr Surg. 1997;100(6):1475–81.

    Article  CAS  Google Scholar 

  25. Gherardini G, G¸rlek A, Cromeens D, Joly GA, Wang BG, Evans GR. Drug-induced vasodilation: in vitro and in vivo study on the effects of lidocaine and papaverine on rabbit carotid artery. Microsurgery. 1998;18(2):90–6.

    Article  CAS  Google Scholar 

  26. Lang EW, Neugebauer M, Ng K, Fung V, Clouston P, Dorsch NW. Facial nerve palsy after intracisternal papaverine application during aneurysm surgery—case report. Neurol Med Chir (Tokyo). 2002;42(12):565–7.

    Article  Google Scholar 

  27. Zhou W, Ma C, Huang C, Yan Z. Intra- and post-operational changes in pupils induced by local application of cisternal papaverine during cerebral aneurysm operations. Turk Neurosurg. 2014;24(5):710–2.

    PubMed  Google Scholar 

  28. Zhou X, Alambyan V, Ostergard T, Pace J, Kohen M, Manjila S, et al. Prolonged intracisternal papaverine toxicity: index case description and proposed mechanism of action. World Neurosurg. 2018;109:251–7.

    Article  Google Scholar 

  29. Zygourakis CC, Vasudeva V, Lai PM, Kim AH, Wang H, Du R. Transient pupillary dilation following local papaverine application in intracranial aneurysm surgery. J Clin Neurosci. 2015;22(4):676–9.

    Article  CAS  Google Scholar 

  30. Liu JK, Sayama CM, Shelton C, MacDonald JD. Transient facial nerve palsy after topical papaverine application during vestibular schwannoma surgery. Case report. J Neurosurg. 2007;107(5):1039–42.

    Article  Google Scholar 

  31. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–7.

    Article  CAS  Google Scholar 

  32. Chadwick GM, Asher AL, Van Der Veer CA, Pollard RJ. Adverse effects of topical papaverine on auditory nerve function. Acta Neurochir. 2008;150(9):901–9; discussion 9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, San Filippo Neri Hospital—ASLRoma1, Rome, Italy

    Alberto Campione, Carlo Giacobbo Scavo, Guglielmo Cacciotti, Raffaelino Roperto & Luciano Mastronardi

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  1. Alberto Campione
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  2. Carlo Giacobbo Scavo
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  3. Guglielmo Cacciotti
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  4. Raffaelino Roperto
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  5. Luciano Mastronardi
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Editors and Affiliations

  1. Unit of Neurosurgery ASLRoma1, San Filippo Neri Hospital, Roma, Italy

    Luciano Mastronardi  & Alberto Campione  & 

  2. Neurosurgery Department, Duke Medical Center, Raleigh, NC, USA

    Takanori Fukushima

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Campione, A., Giacobbo Scavo, C., Cacciotti, G., Roperto, R., Mastronardi, L. (2019). Diluted Papaverine for Microvascular Protection of Cranial Nerves. In: Mastronardi, L., Fukushima, T., Campione, A. (eds) Advances in Vestibular Schwannoma Microneurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-03167-1_14

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  • DOI: https://doi.org/10.1007/978-3-030-03167-1_14

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03166-4

  • Online ISBN: 978-3-030-03167-1

  • eBook Packages: MedicineMedicine (R0)

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