Reversal of cerebral vasospasm by sphenopalatine ganglion stimulation in a dog model of subarachnoid hemorrhage

Background: Sphenopalatine ganglion stimulation dilates the ipsilateral arteries of the normal dog anterior circle of Willis. This experiment tested whether similar stimulation would reverse cerebral vasospasm. Methods: Six dogs underwent baseline angiography followed by creation of subarachnoid hemorrhage (SAH) by injection of autologous blood into the cisterna magna. Two days later, subarachnoid blood injection was repeated. Seven days later, angiography was repeated and the left sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was then stimulated electrically 3 times and angiography repeated during, and 15 and 30 minutes after stimulation. The protocol was repeated again. Adequacy of stimulation was confirmed by the presence of immediate ipsilateral nasal mucus production. Results: Subarachnoid hemorrhage was associated with significant vasospasm of both middle cerebral arteries (11% +/- 4% and 18% +/- 7%, P <.05, paired t tests). Exposure of the ganglion and sham stimulation produced no substantial changes in arterial diameters compared with the diameter before stimulation and after ganglion exposure (n = 2-6 per measurement, paired t tests). Ganglion stimulation produced significant dilatation of the ipsilateral extracranial and intracranial internal carotid, middle cerebral, and anterior cerebral arteries compared with the contralateral arteries (13% +/- 6% to 32% +/- 14%, P <.05, paired t tests). Conclusions: The mild to moderate vasospasm that results from SAH in dogs was reversed by sphenopalatine ganglion stimulation. Since this method carries a potential for human application, additional studies are warranted to determine the effects on more severe vasospasm. (c) 2005 Elsevier Inc. All rights reserved.