+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Transient pupillary dilation following local papaverine application in intracranial aneurysm surgery

Transient pupillary dilation following local papaverine application in intracranial aneurysm surgery

Journal of Clinical Neuroscience 22(4): 676-679

Isolated cases of transient pupillary changes after local intracisternal papaverine administration during aneurysm surgery have been reported. This study aimed to determine the prevalence and factors associated with this phenomenon. We assessed a total of 103 consecutive patients who underwent craniotomy for cerebral aneurysm clipping for the presence of postoperative pupillary dilation (mydriasis) after intracisternal papaverine administration. Univariate and multivariate logistic regression were conducted to evaluate the association of mydriasis with patient age, sex, duration of surgery, and aneurysm location. We observed either ipsilateral or bilateral pupillary dilation in the immediate postoperative period in nine out of 103 patients (8.7%). This phenomenon was not associated with patient age or sex. There was a trend towards positive correlation with aneurysms located at the anterior communicating artery (odds ratio 3.76, p=0.10), and a negative correlation with the duration of surgery (odds ratio 0.57, p=0.08). All pupillary dilation resolved within several hours, and the onset and resolution were consistent with the half-life of papaverine. To our knowledge, this represents the largest study of posteropative pupillary changes due to papaverine. The current findings are consistent with the small number of prior case reports of transient pupillary changes after papaverine administration and appear to reflect the local anesthetic action of papaverine on the oculomotor nerve.

(PDF emailed within 0-6 h: $19.90)

Accession: 059158912

Download citation: RISBibTeXText

PMID: 25564265

DOI: 10.1016/j.jocn.2014.10.016

Related references

Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm. Surgical Neurology 72(6): 770-771, 2010

Cardiac arrest after intracisternal papaverine instillation during intracranial aneurysm surgery. Case report. Journal of Neurosurgery 113(4): 760-762, 2010

Association of acute onset hypertension and tachycardia following intracisternal papaverine administration during intracranial aneurysm surgery: a case report and review of the literature. Journal of Clinical Anesthesia 23(3): 224-226, 2011

Properties of the pupillary dilation produced by the humoral factor in the pupillary reflex dilation: an experimental study in the cat. Japanese Journal of Ophthalmology 33(4): 490-500, 1989

Intra- and post-operational changes in pupils induced by local application of cisternal papaverine during cerebral aneurysm operations. Turkish Neurosurgery 24(5): 710-712, 2015

Facial nerve palsy after intracisternal papaverine application during aneurysm surgery--case report. Neurologia Medico-Chirurgica 42(12): 565-567, 2003

Transient bilateral pupillary dilation from scopolamine discs. Drug Intelligence & Clinical Pharmacy 20(12): 986-987, 1986

Transient facial nerve palsy after topical papaverine application during vestibular schwannoma surgery. Case report. Journal of Neurosurgery 107(5): 1039-1042, 2007

Transient benign unilateral pupillary dilation in young adults. Archives of Neurology 31(1): 12-14, 1974

Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review. Journal of Neurosurgical Anesthesiology 23(1): 35-40, 2011

Bilateral pupillary dilatation after intracisternal papaverine application. Anesthesia and Analgesia 102(3): 965-965, 2006

Adenosine-induced transient asystole during intracranial aneurysm surgery: indications, dosing, efficacy, and risks. Acta Neurochirurgica 157(11): 1879-86; Discussion 1886, 2016

Transient subacute cerebellar ataxia in a patient with Lambert-Eaton myasthenic syndrome after intracranial aneurysm surgery. Clinical Neurology and Neurosurgery 110(5): 480-483, 2008

Correlation of transient neurological deficit and somatosensory evoked potentials after intracranial aneurysm surgery. Case report. Journal of Neurosurgery 59(1): 146-149, 1983