gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Relation between delayed cerebral ischemia and aneurysm localization in patients with aneurysmatic subarachnoid hemorrhage

Meeting Abstract

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  • Helene Hurth - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Milan Stanojevic - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Ulrich Birkenhauer - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Jochen Steiner - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Ulrike Ernemann - Neuroradiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Marcos Tatagiba - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Florian H. Ebner - Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 215

doi: 10.3205/17dgnc778, urn:nbn:de:0183-17dgnc7788

Published: June 9, 2017

© 2017 Hurth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To determine the area most at risk of delayed cerebral ischemia (DCI) in relation to the localization of the ruptured aneurysm in patients with aneurysmatic subarachnoid hemorrhage (aSAH).

Methods: We retrospectively analyzed the occurrence and localization of delayed cerebral ischemia (defined as a visible infarction on cranial computed tomography scans 6 weeks after an aSAH) and their relation to the site of the ruptured aneurysm in all patients who were treated at our neurosurgical intensive care unit between 2007 and 2014 due to an aSAH.

Results: 28,7 % of ruptured aneurysms were localized at the middle cerebral artery (MCA), 24,6 % at the anterior cerebral artery (ACA), 22,1 % at the anterior communicating artery (AcomA), 19,5 % at the internal carotid artery/posterior communicating artery (ICA/PcomA), and 5,1 % originated from posterior circulation arteries, respectively. DCI occurred in 18,1 % of all admitted patients. 4,8 % of patients died within 6 weeks after the bleeding and were excluded from further analyses. There was no significant difference in the occurrence of DCI based on the localization of the aneurysm. Of all patients with an aneurysm of the ICA/Pcom who developed a DCI, 85,7% presented with a DCI of the ipislateral MCA supply area. In 85% of patients with an ACA aneurysm, who developed a DCI, an ischemia of the contralateral ACA supply area occurred whereas 71,4% showed a DCI of the ipsilateral ACA supply area. All patients with DCIs after the rupture of an AcomA aneurysm showed a DCI of the right ACA supply area. Also, all patients with an aneurysm of the MCA or an aneurysm of the posterior circulation, who developed a DCI, presented with a DCI of the ipsilateral MCA supply area.

Conclusion: Few studies exist which could determine the area most at risk of delayed cerebral ischemia after an aSAH. Our analyses confirmed the hypothesis that the area supplied by the artery carrying the ruptured aneurysm is the one most at risk of a DCI in many cases. However, in ACA aneuryms the contralateral ACA supply area was endangered even more often. In aneurysms of the posterior circulation DCIs occurred most likely in the ipsilateral MCA supply area. These findings may help with choosing the probe position during multimodal neuromonitoring and prevention of DCI.