Brain monoamine metabolites and tryptophan in ventricular CSF of patients with spasm after aneurysm surgery

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Abstract
Intraventricular pressure was followed continuously after operation for intracranial arterial aneurysm in 20 patients. Ventricular CSF, homovanillic acid (HVA), tryptophan and 5-hydroxyindole acetic acid (5-HIAA) were analyzed daily for 5 days, beginning before the clipping of the aneurysm. Postoperatively, 7 patients had spasm, verified clinically and angiographically. Seven other patients with no clinical or angiographic signs of spasm, hydrocephalus or increased intracranial pressure (ICP) served as controls. Of the 20 patients, 9 were hydrocephalic. The mean .+-. SE values of HVA, tryptophan and 5-HIAA in the controls were 264 .+-. 40, 1116 .+-. 85 and 88 .+-. 8 ng/ml, respectively, in the controls, and 182 .+-. 20, 982 .+-. 89 and 78 .+-. 3 ng/ml, respectively, in the patients with spasm. The differences were not statistically significant. The low values of HVA may be produced by ischemic changes caused by the spasm. In hydrocephalic patients ventricular CSF tryptophan levels were statistically significantly higher, and 5-HIAA levels lower than in controls. In patients with increased ICP neither alterations nor intercorrelations of monoamine metabolites and tryptophan were found. The results did not give direct support to prophylactic neuropharmacological treatment of postoperative arterial cerebral spasm. However, ventricular HVA, tryptophan, and 5-HIAA measurements can be used for prognostic purposes during the 1st few days after the operation.