gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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

Meeting Abstract

  • presenting/speaker Roland Roelz - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Christian Scheiwe - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Istvan Csok - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Christine Steiert - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Karl Egger - Universitätsklinikum Freiburg, Neuroradiologie, Freiburg, Deutschland
  • Wolf-Dirk Niesen - Universitätsklinikum Freiburg, Neurologie, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Volker Coenen - Universitätsklinikum Freiburg, Stereotaxie und Funktionelle Neurochirurgie, Freiburg, Deutschland
  • Peter Reinacher - Universitätsklinikum Freiburg, Stereotaxie und Funktionelle Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV133

doi: 10.3205/19dgnc148, urn:nbn:de:0183-19dgnc1484

Veröffentlicht: 8. Mai 2019

© 2019 Roelz 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: 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.