gms | German Medical Science

66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

Is there an influence of routine daily transcranial doppler examination on clinical outcome in patients with aneurysmal subarachnoid hemorrhage?

Meeting Abstract

  • Gregory Ehrlich - Neurochirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg
  • Thomas Kirschning - Klinik für Anästhesiologie und operative Intensivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg
  • Aldemar Andres Hegewald - Neurochirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg
  • Peter Schmiedek - Neurochirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg
  • Johann Scharf - Abteilung für Neuroradiologie, Medizinische Fakultät Mannheim, Universität Heidelberg
  • Marcel Seiz-Rosenhagen - Neurochirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.14.01

doi: 10.3205/15dgnc343, urn:nbn:de:0183-15dgnc3434

Veröffentlicht: 2. Juni 2015

© 2015 Ehrlich et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Transcranial Doppler (TCD) is considered to be an established method to detect vasospasm (VS) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The daily measurement of the mean blood flow in intracranial basal arteries is routine in many departments. However, there are well known technical limitations of this method, e.g. experience of the examiner. Until now, there is no data about the benefit of this investigation for patients with aSAH. Therefore, we sought to compare 2 cohorts of patients with and without daily TCD after aSAH with regard to clinical outcome.

Method: All patients with an aSAH admitted between 1/2013 to 9/2014 were included. Patients in a poor clinical condition who did not reach definitive treatment were excluded. All patients were under continuous monitoring in the intensive care unit. A standardized management protocol was used. Following diagnostic workup, the ruptured aneurysm was treated by coiling or clipping within 48 h. A DSA was routinely done in all patients 8 (± 2) days after the hemorrhage for evaluation of VS and to demonstrate complete occlusion of the ruptured aneurysm. DAS was done in addition whenever there was a suspicion of VS resulting in clinical deterioration of the patient. Data on the grade of the hemorrhage (Hunt+Hess grade), severity of bleeding (BNI grade), localisation of the aneurysm and evidence of angiographic or clinical VS were collected. The GOS was used as outcome parameter. All data were prospectively collected and retrospectively analysed. For statistical analysis Chi-square and Mann-Whitney U test was used.

Results: Of 89 included patients 50 belonging to group1 had daily TCD measurements. 39 patients belonging to group2 were treated more recently without routine TCD studies. Patient characteristics and clinical data were comparable for both groups. Treatment modality of the aneurysm was not different between the groups (p=0,7756). Hunt+Hess grade (p=0,818) and the BNI grade (p=0,1551) were both not significantly different. There was no significant difference concerning the incidence of angiographic or clinical VS (p=0,5842 and 0,7933). GOS as the primary outcome parameter showed no significant difference in morbidity and mortality (mortality group 1: 14%, group 2: 15,3%; p=0,8544).

Conclusions: With the limitation of an explorative cohort study the results suggest that routine TCD studies do not improve the overall outcome of patients with aSAH. Therefore routine use of TCD in these patients seems to be questionable.