Development of an intraoperative automatic head shaking system for irrigating aneurysmal subarachnoid hemorrhages

Abstract

In order to prevent cerebral vasospasm in SAH patients, we have been using tissue plasminogen activator (tPA). Through several trial-and-error tests on how to administration tPA, we conclude that intraoperative high- dose (360 x 104IU)administration of tPA is the most effective method for clot lysis. In addition to preventing hemorrhagic complications, excessive remaining tPA was removed by washing with large amounts of electrolyte fluid. The most important consideration regarding these processes is how to improve contact efficiency between tPA and subarachnoid clots as widely and fast as possible. In order to cope with such an efficiency issue, we have developed an intraoperative automatic head shaking system. This system was designed for installation in any kind of operating bed. After the clipping of an aneurysm, head shaking commences during irrigation of the subarachnoid space and continues for nearly 20 minutes. Compared with our previous series, results were excellent for this series in both terms of extensive clot lysis and decreased severity of cerebral vasospasm. We will attempt further clinical studies as improvements are made to the intraoperative automatic head shaking system.