gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Induced hypertension in treating cerebral vasospasm in the presence of unsecured intracranial aneurysms: Is Triple-H therapy safe?

Meeting Abstract

  • J. Platz - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • E. Güresir - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • H. Vatter - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • J. Berkefeld - Institut für Neuroradiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • A. Raabe - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • V. Seifert - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • J. Beck - Neurochirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.05-08

DOI: 10.3205/09dgnc142, URN: urn:nbn:de:0183-09dgnc1428

Published: May 20, 2009

© 2009 Platz et al.
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Outline

Text

Objective: Permanent neurologic deficits or death caused by cerebral vasospasm (CVS) remains a challenging problem after subarachnoid haemorrhage (SAH). Treatment by an induced hypertension represents a widely accepted conventional therapy of CVS. However, the risk of this hypertension in the presence of unsecured intracranial aneurysms concerning a re-bleeding is not well characterized so far and represents a limitation of this therapy. Therefore, the aim of the present study was the assessment of the safety of the induced hypertension in patients with unsecured aneurysms.

Methods: Over a 10-year period, patients suffering from SAH, requiring hypertensive therapy due to CVS were entered into a prospectively conducted database. Patients harbouring additional unsecured aneurysms and requiring Triple-H therapy due to cerebral vasospasm were identified. Any event of bleeding or re-bleeding was recorded.

Results: During the observation period, 43 patients with 120 aneurysms received hypertensive therapy. By the start of Triple-H therapy, 39 patients had 68 unsecured unruptured aneurysms and 4 patients had 4 unsecured ruptured aneurysms whereas 48 aneurysms had been secured (n=32 by clipping, n=16 by coiling). Mean aneurysm size in all patients was 5.5±3.6 mm (unsecured: 4.1±2.0 mm). Additional to Triple-H therapy, 17 patients underwent endovascular treatment of vasospasm by balloon-dilatation and/or intra-arterial nimodipine infusion. No aneurysm rupture due to the initiated therapies was observed in our series.

Conclusions: The present data suggests that hyperdynamic therapy is safe. Considering the risk of infarction by delayed CVS, induced hypertension should not be omitted because of unsecured aneurysms, although further studies are needed, as the number of patients available is limited.