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Meta-Analysis
. 2025 May 19;48(1):423.
doi: 10.1007/s10143-025-03563-5.

Efficacy and safety of intraventricular nimodipine in patients with aneurysmal subarachnoid hemorrhage compared to oral nimodipine: a systematic review and meta-analysis

Hesham Kelani  1 , Nancy Ibrahim  2 , Ahmed Naeem  3 , Hazem Mohamed Salamah  4 , Nada Ashraf Al-Shafey  2 , Yousef Tanas  2 , Esraa Shawky Ibrahem  2 , Fawzy Mohamed Fawzy Naga  2 , Volodymyr Vulkanov  5 , Mohamed Jadidi  1 , David P Lerner  1 , Ketevan Berekashvili  1 , Moshe A Mizrahi  1 , Alexander Andreev  6 , Diana Greene-Chandos  7 , Athos Patsalides  8
Affiliations
Meta-Analysis

Efficacy and safety of intraventricular nimodipine in patients with aneurysmal subarachnoid hemorrhage compared to oral nimodipine: a systematic review and meta-analysis

Hesham Kelani et al. Neurosurg Rev. .

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Nimodipine is the only drug approved and administered orally as well as intravenously to improve the outcomes of patients with vasospasm post-SAH. EG-1962 is a sustained-release formulation of nimodipine administered into the subarachnoid space in patients with aSAH. We hypothesize that this may improve the efficacy of nimodipine and minimize its adverse effects. We searched PubMed, Cochrane, Scopus, and Web of Science on August 2, 2024, using relevant keywords. Studies were screened for eligibility. We extracted the data from the relevant articles and then these data were pooled as risk ratio (RR) and 95% confidence interval (CI), using R software. Pooled data from trials comparing intraventricular nimodipine with oral nimodipine showed a significantly lower risk of angiographic vasospasm in the intraventricular nimodipine cohort than the oral nimodipine cohort (RR = 0.8, CI [0.65-0.98]), and a trend towards lower risk of delayed cerebral ischemia and hypotension. No significant difference in extended Glasgow coma scale (eGCS) at 90 days of follow-up and other adverse events like hydrocephalus, bacterial meningitis, and serious adverse events including death. The risk of angiographic vasospasm was lower with intraventricular nimodipine compared with oral nimodipine, and there was a trend toward a decreased incidence of DCI and hypotension, which should be validated in future studies. However, there is no significant improvement in functional outcomes from intraventricular nimodipine. More rigorous research is needed to look at the underlying mechanisms and see if other factors influence the functional outcomes. Clinical trial number Not applicable.

Keywords: Delayed cerebral ischemia; Meta-analysis; Nimodipine; Subarachnoid hemorrhage; Vasospasm.

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Conflict of interest statement

Declarations. Ethical approval: Not applicable. Consent to participate: Not applicable. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram shows the detailed search and selection process
Fig. 2
Fig. 2
A summary of the risk of bias of the included studies
Fig. 3
Fig. 3
Forest plot shows the favorable functional outcome at day 90 as measured by the extended Glasgow coma scale (eGCS ≥ 6) among people of different World Federation of Neurological Surgeons (WFNS) grades
Fig. 4
Fig. 4
Forest plot shows the secondary outcomes
See this image and copyright information in PMC

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