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J Neurol Surg A Cent Eur Neurosurg 2017; 78(06): 548-555
DOI: 10.1055/s-0036-1594005
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effect of Visible Light on Vasospasticity of Post–Subarachnoid Hemorrhage Cerebrospinal Fluid

Pulat Akin Sabanci
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
,
Bulent Omay
2   Department of Neurosurgery, Yale University, School of Medicine, New Haven, Connecticut, United States
,
Yavuz Aras
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
,
Aydın Aydoseli
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
,
Achmet Ali
3   Department of Anesthesiology, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
,
Tulin Erdem
4   Department of General ICU, Anadolu Saglik Merkezi, Kocaeli, Turkey
,
Altay Sencer
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
,
Talat Kiris
5   Department of Neurosurgery, Liv Hospital, Istinye University, İstanbul, Turkey
› Author Affiliations
Further Information

Publication History

26 June 2016

14 September 2016

Publication Date:
08 June 2017 (online)

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Abstract

Background and Objective Cerebral vasospasm (CV) is a serious complication of subarachnoid hemorrhage (SAH) with high morbidity and mortality rates. The mechanism of CV has not been determined. There are many theories related to this unsolved issue, one of which supports CV as a two-stage phenomenon from a pathophysiologic perspective. The first stage consists of inhibition of neuronal nitric oxide synthase by oxyhemoglobin, which results in a decrease of nitric oxide (NO) production. The second stage consists of an increase in the levels of asymmetric dimethylarginine through bilirubin oxidation products (BOXes), which are oxidized by-products of hemoglobin metabolism. These in turn inhibit endothelial nitric oxide synthase (eNOS), which results in the blockage of the second NO production mechanism. BOXes are sensitive to visible light, as is their precursor bilirubin. The hypothesis of CV prevention using the photosensitivity of BOXes was tested in this study.

Material and Methods Cerebrospinal fluid (CSF) obtained from two patients with SAH was divided in half and either exposed to a standard dose of visible light or not exposed to any light. The CSF was spectrophotometrically investigated and the concentration of BOXes was measured. A comparison between CSF samples exposed to light and not exposed to light was made. Using two groups of 16 rats each, the vasospastic effect of the CSF exposed and not exposed to light on arteries of the cortical surface was measured. The cortex was exposed using the cranial window.

Results Spectrophotometric analysis revealed that the concentration of BOXes in the CSF decreased significantly after being exposed to visible light (p < 0.001). There was a significant difference of the vasospastic effect of CSF on exposed cortical arteries (p < 0.001).

Conclusion The concentration of BOXes and the vasospastic effect of CSF taken from patients with SAH were significantly reduced after being exposed to visible light if compared with CSF not exposed to light.

Keywords

subarachnoid hemorrhage - cerebral vasospasm - photosensitivity - CSF - BOX
 

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