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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Detection of cerebral hypoperfusion after aneurysmal subarachnoid haemorrhage by ultrasound perfusion imaging – a prospective trial

Detektion der zerebralen Hypoperfusion nach aneurysmatischer Subarachnoidalblutung mittels Ultraschallperfusionsbildgebung – eine prospektive Studie

Meeting Abstract

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  • presenting/speaker Christian Fung - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Dieter Henrik Heiland - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland
  • Raluca Reitmeir - Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
  • Jens Eyding - Klinikum Dortmund, Neurologie, Dortmund, Deutschland
  • Andreas Raabe - Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
  • Jan Gralla - Universitätsspital Bern, Institut für Diagnostische und Interventionelle Neuroradiologie, Bern, Switzerland
  • Werner Z\'Graggen - Universitätsspital Bern, Neurochirurgie, Bern, Switzerland
  • Jürgen Beck - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV160

doi: 10.3205/20dgnc158, urn:nbn:de:0183-20dgnc1583

Veröffentlicht: 26. Juni 2020

© 2020 Fung 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: Cerebral vasospasm contributes to increased morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Current methods for screening and detection of cerebral vasospasm have either a low sensitivity and specificity, are dependent on x-ray, are costly, and/or extremely time-consuming and laborious. Ultrasound perfusion imaging is a non-invasive tool that measure cerebral perfusion, is applicable bedside and at will repeatable. This prospective trial investigates ultrasound perfusion imaging (UPI) in aSAH patients to detect impaired perfusion in the setting of cerebral vasospasm.

Methods: High mechanical index contrast-enhanced ultrasound was prospectively used in 30 patients suffering of aSAH throughout multiple time points between day 3 and day 14 after ictus. Delayed ischemic neurologic deficit (DIND) were defined as new neurological deficit or drop in GCS by 2 points. Time-to-peak (TTP) intensity and mean transit time (MTT) of 4 regions of interest (ROIs) of the middle cerebral artery (MCA) territory per patient were quantified by UPI and midbrain perfusion records were used to normalize the MCA territory measurements. We analyzed absolute values and performed intra- and interhemispheric comparisons. The correlation between the least perfused regions (measured by UPI or CTP) and occurrence of DIND was investigated by non-parametric tests.

Results: 18 patients had no DIND and 12 patients presented a DIND. The left-right difference of the minimal obtained perfusion predicts most likely a potential vasospasm. In DIND patients TTP values showed a significant increase after day 6 with a peak at day 8-10 compared to no-DIND patients. TTP values showed a significant difference between the DIND and no-DIND group (p=0.005).

Conclusion: UPI combines features of an optimal screening tool to be applied in the daily routine. It can detect cerebral hypoperfusion after aSAH.