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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Enteral or parenteral nimodipine treatment in vestibular schwannoma surgery – a comparative pharmacokinetic study

Meeting Abstract

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  • Christian Scheller - Department of Neurosurgery, University of Halle-Wittenberg, Germany
  • Andreas Wienke - Institute of Medical Epidemiology, Biostatistics, and Informatics, University of Halle-Wittenberg, Germany
  • Franziska Wurm - Department of Neurosurgery, University of Halle-Wittenberg, Germany
  • Sebastian Simmermacher - Department of Neurosurgery, University of Halle-Wittenberg, Germany
  • Eva Herzfeld - Department of Neurosurgery, University of Halle-Wittenberg, Germany
  • Christian Strauss - Department of Neurosurgery, University of Halle-Wittenberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.10.08

doi: 10.3205/13dgnc364, urn:nbn:de:0183-13dgnc3640

Published: May 21, 2013

© 2013 Scheller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Oral nimodipine is recommended to reduce poor outcome related to aneurysmal subarachnoid hemorrhage (SAH). In addition, animal experiments and clinical trials revealed a beneficial effect of enteral and parenteral nimodipine for the regeneration of cranial nerves following skull base, laryngeal and maxillofacial surgery. Despite these findings there is a lack of pharmacokinetic data in the literature, especially concerning its distribution in nerve tissue.

Method: Samples were taken from a consecutive series of 57 patients suffering from skull base lesions and treated with nimodipine prophylaxis from the day before surgery until the seventh postoperative day. Both groups received standard dosages for enteral (n=25) and parenteral (n=32) nimodipine medication. Nimodipine levels were measured in serum, cerebrospinal fluid (CSF), and tissue samples including vestibular nerves.

Results: Nimodipine levels were significantly higher following parenteral as compared to enteral administration for intraoperative serum (p<0.001), intraoperative CSF (p<0.001), tumor tissues (p=0.01) and postoperative serum (p<0.001). In addition, nimodipine was significantly more frequently detected in nerve tissue following parenteral administration (Fisher`s exact test, p=0.015).

Conclusions: From a pharmacokinetic point of view parenteral nimodipine medication leads to higher levels in serum and CSF. Furthermore, traces are more frequently found in nerve tissue following parenteral as compared to enteral nimodipine administration, at least in the early course.