gms | German Medical Science

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

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Stellate ganglion block in the treatment of severe symptomatic cerebral vasospasm after subarachnoid hemorrhage – first experience

Meeting Abstract

  • Firas Thaher - Klinik für Neurochirurgie, Katharinenhospital Stuttgart
  • Anne-K. Hickmann - Klinik für Neurochirurgie, Katharinenhospital Stuttgart
  • R. Scheibe - Klinik Anästhesiologie und Operative Intensivmedizin, Katharinenhospital Stuttgart
  • P. Kurucz - Klinik für Neurochirurgie, Katharinenhospital Stuttgart
  • M. Sauter - Klinik für Neurochirurgie, Katharinenhospital Stuttgart
  • Minou Nadji-Ohl - Klinik für Neurochirurgie, Katharinenhospital Stuttgart
  • Markus Bittl - Klinik für Neurochirurgie, Katharinenhospital Stuttgart

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.11.07

doi: 10.3205/14dgnc182, urn:nbn:de:0183-14dgnc1820

Published: May 13, 2014

© 2014 Thaher 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: The treatment of cerebral vasospasm (CVS) remains a major challenge in the treatment of patients following aneurysmal subarachnoid hemorrhage. Stellate ganglion block (SGB) improves cerebral perfusion by decreasing the cerebral vascular tone due to temporary chemical sympathectomy. This procedure, which can be performed bedside, may be an effective modality of treatment for CVS. We report our first experiences with stellate ganglion block in the treatment of severe CVS secondary to SAH.

Method: Fifteen consecutive patients with symptomatic CVS have been treated when conservative treatment failed and patients were not stable enough for invasive treatment such as local application of vasodilators requiring angiography. All patients were monitored by transcranial Doppler sonography (TCD) and serial clinical evaluation of neurologic status. In intubated and sedated patients brain tissue oxygenation (ptiO2) was monitored. SGB was performed using 8-10 ml of ropivacain 2mg/ml on the side with maximum cerebral blood flow velocity. Neurological status, TCD, and ptiO2 were assessed after SGB.

Results: Four patients experienced neurologic improvement following SGB. In 14 patients a decrease in blood flow velocity measured by TCD was documented. 10 intubated and sedated patients showed a relevant increase in ptiO2. Recurrence of vasospasm was seen in 5 patients. In four of them a successful treatment of vasospasm could be achieved by repeat SGB. One patient with recurrent spasm and failure to improve ptiO2 values as well as TCD results underwent intra-arterial milrinone application once stable enough for angiography to improve cerebral perfusion. One patient died of the consequences of severe vasospasm despite maximal medical treatment.

Conclusions: Stellate ganglion block seems to be a simple and minimally invasive technique adjunct to the standard therapy to improve cerebral perfusion with an immediate and persisting effect.