Abstract
Background and Study Aims/Object Oral nimodipine is recommended to reduce poor outcome related to aneurysmal subarachnoid
hemorrhage (SAH). In addition, animal experiments and clinical trails revealed a beneficial
effect of enteral and parenteral nimodipine for the regeneration of cranial nerves
following skull base, laryngeal, and maxillofacial surgery. Despite these findings
there is a lack of pharmacokinetic data in the literature, especially concerning its
distribution in nerve tissue.
Patients/Material and Methods Samples were taken from a consecutive series of 57 patients suffering from skull
base lesions and treated with nimodipine prophylaxis from the day before surgery until
the seventh postoperative day. Both groups received standard dosages for enteral (n = 25) and parenteral (n = 32) nimodipine . Nimodipine levels were measured in serum, cerebrospinal fluid
(CSF), and tissue samples, including vestibular nerves.
Results Nimodipine levels were significantly higher following parenteral as compared with
enteral administration for intraoperative serum (p < 0.001), intraoperative CSF (p < 0.001), tumor tissues (p = 0.01), and postoperative serum (p < 0.001). In addition, nimodipine was significantly more frequently detected in nerve
tissue following parenteral administration (Fisher's exact test, p = 0.015).
Conclusions From a pharmacokinetic point of view, parenteral nimodipine medication leads to higher
levels in serum and CSF. Furthermore, traces are more frequently found in nerve tissue
following parenteral as compared with enteral nimodipine administration, at least
in the early course.
Keywords
nimodipine - pharmacokinetic - subarachnoid hemorrhage - skull base surgery
