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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Distribution of cerebral vasospasm in relation to the vessel territory of the ruptured aneurysm

Verteilung des zerebralen Vasospasmus in Relation zum Versorgungsgebiet des rupturierten Aneurysmagefäß

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  • corresponding author C.T. Ulrich - Abteilung für Neurochirurgie, Universitätsklinikum Frankfurt/Main
  • H. Vatter - Abteilung für Neurochirurgie, Universitätsklinikum Frankfurt/Main
  • V. Seifert - Abteilung für Neurochirurgie, Universitätsklinikum Frankfurt/Main
  • A. Raabe - Abteilung für Neurochirurgie, Universitätsklinikum Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.06.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc191.shtml

Published: May 8, 2006

© 2006 Ulrich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Invasive monitoring of brain tissue oxygen, focal cerebral blood flow or microdialysis may be used to diagnose delayed ischemia and to assist triple-H treatment after subarachnoid hemorrhage (SAH). However, these measurements are highly focal and performed under the assumption that most likely the spasm will occur in the territory of the parent vessel of the ruptured aneurysm. Despite the clinical use, there are no data in the literature that support this assumption. We sought to objectify the likelihood that a focally placed probe will indeed be situated in the territory of the most likely significant vasospasm (VS).

Methods: We evaluated 78 patients out of our database admitted to our department between 09/1999 and 08/2005 with a SAH and a subsequent vasospasm due to a ruptured aneurysm. The vasospasm demonstrated in the angiography was severe (≥50% of stenosis). In retrospect we analysed the correlation between expected and found VS in relation of the ruptured aneurysm vessel to predict if the probe placement would be wrong or right. The usual probe location in internal carotid artery-aneurysms (ICA-A), middle cerebral artery (MCA)-A and vertebral-basilar (VB)-A is the ipsilateral (IL) MCA area and for the anterior communicating artery (ACOM)-A it is the anterior cerebral artery (ACA) on the right side.

Results: The likelihood to locate the probe in the most vasospastic territory was 62% (48/78) overall. There were 23 ICA-A. The expected peak of VS in those was the IL MCA area. We found that the VS occurred on this side in 70% (16). The success rate was highest in nine (82%) of eleven MCA-A. We found that the VS was located in the estimated area of the IL MCA. In the group of 24 ACOM-A the expected vasospastic ACA on the right side were present in 16 cases (67%). In two ACA-A there were no VS in the predicted area (ACA on the right). Eighteen aneurysms of the VB area (6 basilar arteries, 4 posterior cerebral arteries, 4 vertebral arteries, 2 posterior communicating arteries, 1 posterior inferior cerebellar artery, 1 superior cerebellar artery) were evaluated and found to have VS on the right MCA area in only 39% (7).

Conclusions: When a focal measurement probe is placed in the territory of the parent vessel of the ruptured aneurysm, the likelihood to access the expected area of VS seems to be good for the ICA and MCA. Nevertheless, there was no significant predictability for the ACOM- and the VB-A.