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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(01): 040-042
DOI: 10.4103/2348-0548.173243
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Papaverine is a confounding factor in neurological assessment after cerebral aneurysm clipping: Report of three cases and review of the literature

Veena Sheshadri
Department of Neuroanaesthesia, Vikram Hospitals, Bengaluru, Karnataka, India
,
Rohini Surve
Department of Neuroanaesthesia, Vikram Hospitals, Bengaluru, Karnataka, India
,
B. A. Chandramouli
1   Department of Neurosurgery, Vikram Hospitals, Bengaluru, Karnataka, India
› Author Affiliations
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Publication History

Publication Date:
03 May 2018 (online)

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Abstract

Intracisternal papaverine instillation is being used across many centers after cerebral aneurysm clipping to prevent and treat cerebral vasospasm. Pupillary dilatation secondary to papaverine can interfere with the neurological assessment postoperatively. This report describes pupillary changes in three patients following the papaverine application after craniotomy and aneurysm clipping, with one patient developing contralateral pupillary dilatation and the other two having bilateral pupillary dilatation. The pupillary changes resolved over 30 min to 4 h postoperatively. We conclude that pupillary changes following papaverine instillation could be a transient phenomenon and should not be considered ominous in absence of new onset neurological deficits. Intraoperative somatosensory evoked potential monitoring also helped in postoperative decision making in all our cases.

Keywords

Aneurysm clipping - intracisternal papaverine - pupillary dilatation and areflexia
 

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