ANA Discussion Forum

Pre-Treatment Options => Pre-Treatment Options => Topic started by: TotemCarver on November 08, 2018, 11:49:43 pm

Title: Nimodopine to Improve Facial Nerve Outcomes
Post by: TotemCarver on November 08, 2018, 11:49:43 pm
Early next month I am planning to have Cyberknife hypo-fractionated stereotactic radiotherapy (5 x 5 Gy) for my AN/VS. Perioperative IV administration of nimodipine has been recommended by the Congress of Neurological Surgeons to improve post-op facial nerve outcomes following AN/VS surgery.* The authors write: “... there appears to be a consistent positive effect of treatment with vasoactive agents, specifically nimodipine, on the outcome of the facial nerve over the long term and potentially on hearing preservation. Although IV therapy is likely more efficacious, oral therapy may be of use as well ... Further research is needed to ascertain the true effect of vasoactive treatments for perioperative improvement in long-term facial nerve and cochlear nerve outcomes; however, treatment may be considered to attempt to achieve this effect in one’s individual practice currently.”

I've reviewed several nimodipine articles in the medical literature. My question is does it makes sense for me to take nimodipine in relation to my upcoming radiotherapy? The dosing I am considering is oral nimodipine 60 mg q4h during treatment and beginning 24 hours before I commence treatment.

Nimodipine has not been FDA approved for this use and, apparently, all of the literature on its use in conjunction with AN/VS treatment is in relation to surgery, not radiosurgery or radiotherapy. However, one of articles I considered, by Tong et al., found “Delayed cognitive deficits can be alleviated by calcium antagonist nimodipine by downregulation of apoptosis following whole brain radiotherapy” The investigators used a rat model where the rats received “a single dose of 30 Gy of WBRT followed by nimodipine injection intraperitoneally” at 2.5 ml/kg daily for seven days. (There is another study by Wang et al. (Cytotherapy. 2016 Jan;18(1):53-64. doi: 10.1016/j.jcyt.2015.10.006. PMID: 26719199) that looked at the "Neuroprotective effects of human umbilical cord-derived mesenchymal stromal cells combined with nimodipine against radiation-induced brain injury through inhibition of apoptosis." One arm of the study included nimodipine alone but the abstract doesn't report their findings on that arm and I don't have access to the full text article but they did find that mesenchymal stromal cells plus nimodipine was effective in mice in treating radiation-induced brain injury following whole brain irradiation.)

In any case, my understanding is that brain irradiation induces some analogous types of trauma that are possibly mitigated by nimodipine. On that basis and the strength of evidence for surgical trauma and the relatively mild side effects profile I am inclined to give nimodipine a try.  However, I would like more information to make the best decision.

* See Van Gompel, JJ et al. below.

Excerpts from Select Nimodipine Studies