gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Severe vasopasms and repeated endovascular spasmolysis: critical analysis of a single centre population

Meeting Abstract

  • Daniela Pierscianek - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Anna-Margarete Bohrer - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Marc Schlamann - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
  • Daniela Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.11.03

doi: 10.3205/14dgnc178, urn:nbn:de:0183-14dgnc1782

Published: May 13, 2014

© 2014 Pierscianek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Vasospasms of the intracranial vessels following subarachnoid haemorrhage (SAH) remain a hazardous complication. To date, the incidence of severe vasospasms and the pending variables have not been broadly assessed, neither has the outcome after repetitive endovascular vasospasmolysis.

Method: From 2008 to 2013 a total of 301 patients treated for intracranial aneurysm (IA) in our department suffered initially from SAH. We conducted retrospective studies from the medical charts. 106 patients (76 female, 30 male) developed vasospasms (35.2%). Vasospasms were defined as an increase in mean blood flow velocity (Vmean) in transcranial Doppler sonography of 100% within 24 hours or Vmean exceeding 180 cm/s, correlated with patients’ neurological deterioration. Angiography confirmed vasospasm in all patients. Severe vasospams (SV) were defined when repeated vasospasmolysis was necessary. For assessment of pending variables, CCT scans were evaluated for amount of SAH, intraventricular haemorrhage (IVH), intracerebral haemorrhage (ICH) and infarct demarcation. Clinical outcome at discharge was assessed from medical records using the GOS.

Results: Of 106 patients with SAH and cerebral vasospasms, 42 patients (28 female, 14 male; 38.9%) received repeated vasospasmolysis due to recurrent vasospams. Of all patients suffering from vasospasms, 64 patients were considered for clipping, whereas 49 patients were treated with coil embolization. In 7 patients both, clipping and coiling, were employed for definite embolization. SV were significantly more frequent in patients who underwent clipping compared to coil embolization (p<0.01). With respect to the other pending variables (age, H&H, IVH, ICH, multiple aneurysms, and location) under analysis, only ICH showed negative correlation. ICH was found to be significantly less frequent in patients with SV (p<0.05). Expectedly, infarctions were mostly associated with SV (p<0.001). Repeated vasospasmolysis showed a trend towards an inferior outcome, yet not reaching statistical significance (p>0.05).

Conclusions: In our series, clipping was more frequently associated with the development of SV. This might also be due to the fact, that 61% of patients with clipped aneurysms had severe SAH with a H&H score ≥3. Despite repeated vasospasmolysis and significantly more demarcation of infarctions, patients' outcome with SV was not significantly diminished. This might underline the importance of even repeated vasospasmolysis in the treatment of SAH and SV.