• Vincent Dodson, Neil Majmundar, Mohammad El-Ghanem, Krishna Amuluru, Gaurav Gupta, Rolla Nuoman, John Wainwright, Gurmeen Kaur, Chad Cole, Justin Santarelli, Dipak Chandy, Christian Bowers, Chirag Gandhi, and Fawaz Al-Mufti.
• Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
• World Neurosurg. 2019 May 1; 125: 511-518.e1.

BackgroundIntrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH).ObjectiveThe authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH.MethodsAn electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used.ResultsA total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus.ConclusionsGiven the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted.Copyright © 2019 Elsevier Inc. All rights reserved.

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