Potential Risk of Artificial Cerebrospinal Fluid Solution Without Magnesium Ion for Cerebral Irrigation and Perfusion in Neurosurgical Practice

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  • MORI Kentaro
    Department of Neurosurgery, Juntendo University Shizuoka Hospital Department of Neurosurgery, National Defense Medical College
  • YAMAMOTO Takuji
    Department of Neurosurgery, Juntendo University Shizuoka Hospital
  • MIYAZAKI Masahiro
    Juntendo Casualty Center
  • HARA Yasukazu
    Department of Radiology, Juntendo University Shizuoka Hospital
  • KOIKE Nobuhiro
    Department of Radiology, Juntendo University Shizuoka Hospital
  • NAKAO Yasuaki
    Department of Neurosurgery, Juntendo University Shizuoka Hospital

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Abstract

The effect of irrigation with artificial cerebrospinal fluid (CSF) containing various magnesium ion (Mg2+) concentrations on vasospastic arteries was investigated in the dog. Cerebral vasospasm was induced by the experimental subarachnoid hemorrhage model in 15 beagle dogs. Cisternal irrigation was performed for 1 hour via a microcatheter placed in the cisterna magna with commercially available artificial CSF (ARTCEREB®) with physiological concentration of Mg2+ (2.2 mEq/l) (ACM group, n = 5), ARTCEREB solution without Mg2+ (ACR group, n = 5), and ARTCEREB solution with higher Mg2+ concentration (5 mEq/l) (ACMM group, n = 5). CSF electrolyte concentrations and the diameters of the basilar and vertebral arteries were measured. In the ACM group, no changes were detected in either CSF Mg2+ concentration or arterial diameters. In the ACR group, the CSF Mg2+ decreased significantly to 0.8 ± 0.07 mEq/l from the baseline value of 1.4 ± 0.03 mEq/l, and both basilar and vertebral artery diameters were significantly decreased to 0.61 ± 0.18 mm and 0.57 ± 0.23 mm from their baseline values of 0.74 ± 0.22 mm and 0.68 ± 0.17 mm, respectively. In the ACMM group, the CSF Mg2+ significantly increased to 2.4 ± 0.15 mEq/l from the baseline value of 1.4 ± 0.05 mEq/l, and both basilar and vertebral artery diameters were significantly increased to 0.84 ± 0.19 mm and 0.90 ± 0.22 mm from their baseline values of 0.71 ± 0.21 mm and 0.69 ± 0.24 mm, respectively. Irrigation with artificial CSF solution without Mg2+ causes vasoconstriction of the cerebral artery. Irrigation with artificial CSF with appropriate Mg2+ concentration is essential, especially in patients with subarachnoid hemorrhage.

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