A review of medical treatments of cerebral vasospasm

We review the literature on the established perioperative therapies for cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH). Despite aSAH treatment advances, CV continues to be a significant source of post-SAH morbidity and mortality. In fact, CV has been correlated with a 1.5- to three-fold increase in mortality in the first 2 weeks after SAH. As new treatment modalities show promise in animal models and early clinical trials, greater efforts are needed to test these new approaches. Few evidence-based indications for the treatment of vasospasm currently exist. Large-scale randomized clinical trials are needed to determine whether therapies such as magnesium, statins, nitric oxide modulators, endothelin antagonists and others will become standard of care in the prevention and/or treatment of CV.