Artikel
Stereotactic catheter ventriculocisternostomy and cisternal lavage reduces delayed cerebral infarction and improves outcome in patients with poor grade subarachnoid haemorrhage – a before and after study
Die stereotaktische Katheter-Ventrikulozisternostomie und Zisternenlavage reduziert verzögerte Hirninfarkte und verbessert das neurologische Outcome bei Patienten mit schwerer aneurysmatischer Subarachnoidalblutung – eine Vorher-/Nachher-Studie
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Delayed cerebral infarction (DCI) is an important source of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy is a new method for DCI prevention. Here, we report DCI and neurological outcome in a consecutive and unselected aSAH population 33 months before vs. 33 months after STX-VCS was available.
Methods: 341 consecutive aSAH patients admitted to our center in a 5.5-year period (01/2013–06/2018) were inclued in this study. STX-VCS was available in the second half (33-months period) and 45 of 176 patients (26%) considered at high risk for DCI were offered STX-VCS on the basis of individual treatment decisions. Cisternal lavage was administered via STX-VCS at a rate of 50ml/h using electrolyte solution containing Urokinase at a concentration of 100 I.U./ml. In case of sonographic vasospasm Nimodipine applied at a concentration of 0.005–0.01 mg/ml.
DCI was assessed by an independent and blinded rating board (neuroradiologist/neurologist/neurosurgeon). Neurological outcome was evaluated by an independent and blinded neurologist. Volumetry of DCI regions was performed using Brainlab Elements software.
Results:
Tabelle 1 [Tab. 1]
Tabelle 2 [Tab. 2]
STX-VCS was performed without surgical complications. One adverse event due to cisternal lavage was without sequelae.
Conclusion: Introducing STX-VCS for DCI prevention in high-risk aSAH patients considerably reduced DCI incidence, DCI burden and DCI-related mortality. This was associated with improved neurological outcomes in aSAH patients WFNS Grade 4+5. Safety and efficacy of STX-VCS need to be evaluated in a randomized trial which is under review by regulatory authorities.