gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Repetitive endovascular interventions for refractory cerebral vasospasm induced by aneurysmal subarachnoid haemorrhage: Feasibility and functional outcome

Meeting Abstract

  • L. Andereggen - Institut für Diagnostische und Interventionelle Neuroradiologie, Universität Bern, Inselspital, Bern, Switzerland; Klinik für Neurochirurgie, Universität Bern, Inselspital, Bern, Switzerland
  • J. Beck - Klinik für Neurochirurgie, Universität Bern, Inselspital, Bern, Switzerland
  • W. Z`Graggen - Klinik für Neurochirurgie, Universität Bern, Inselspital, Bern, Switzerland; Klinik für Neurologie, Universität Bern, Inselspital, Bern, Switzerland
  • M. Hänggi - Klinik für Intensivmedizin, Universität Bern, Inselspital, Bern, Switzerland
  • C. Brekenfeld - Institut für Diagnostische und Interventionelle Neuroradiologie, Universität Bern, Inselspital, Bern, Switzerland
  • G. Schroth - Institut für Diagnostische und Interventionelle Neuroradiologie, Universität Bern, Inselspital, Bern, Switzerland
  • A. Raabe - Klinik für Neurochirurgie, Universität Bern, Inselspital, Bern, Switzerland
  • J. Gralla - Institut für Diagnostische und Interventionelle Neuroradiologie, Universität Bern, Inselspital, Bern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.10.08

DOI: 10.3205/11dgnc172, URN: urn:nbn:de:0183-11dgnc1726

Published: April 28, 2011

© 2011 Andereggen et al.
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Outline

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Objective: Cerebral vasospasm (CVS) remains a major cause for delayed neurological morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). In patients suffering from severe CVS which is refractory to medical and hemodynamic therapies, treatment options are limited. This study evaluates the clinical outcome of patients undergoing the approach of repetitive endovascular interventions during treatment of severe CVS.

Methods: During a 2 ½ year period 256 patients with SAH (4.2%) were treated in our neurovascular center. Eleven patients (7 female, 4 male, mean age: 49 years) were retrospectively included in the study. All patients met the criteria of having medically and hemodynamically refractory cerebral vasospasms and in all patients repetitive endovascular interventions (≥3 interventions) were performed during course of the CVS. Interventions consisted of transluminal balloon angioplasty or local administration of nimodipine. Functional outcome was assessed using the GCS score, modified Ranking Scale (mRS) at discharge and at the last follow-up.

Results: A total of 46 angiographic interventions (mean 4.2) were performed in this group of patients, treating a total number of 92 vessels territories (mean 8.7) during the course of CVS. There was no treatment-related mortality. However, in two cases (18.2%) dissection in the access vessel was observed, in one case requiring further treatment. Mean mRS at discharge was 4, mean mRS at the last follow-up was 2.6. In seven patients, the mRS at the last follow-up was ≤2 (63.6%).

Conclusions: The approach of repetitive endovascular interventions during the treatment of severe CVS refractory to medical and hemodynamic therapies is effective. Favourable functional outcome can be achieved in this small selected group of patients.