gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Cerebral vasospasm (CVS)-dependent and CVS-independent cerebral infarctions determine outcome after non-aneurysmal subarachnoid hemorrhage: a single-center series with 250 patients

Meeting Abstract

  • Juergen Konczalla - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany
  • Sepide Kashefiolasl - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany
  • Nina Brawanski - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany
  • Johannes Platz - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany
  • Christian Senft - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany
  • Volker Seifert - Klinik für Neurochirurgie, Goethe-Universätsklinikum, Frankfurt am Main, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.11.07

doi: 10.3205/16dgnc296, urn:nbn:de:0183-16dgnc2965

Published: June 8, 2016

© 2016 Konczalla et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Recently data showed increasing numbers of non-aneurysmal subarachnoid hemorrhage (NASAH). For aneurysmal SAH data showed that clinical outcome and infarctions are CVS-dependent and CVS-independent. However, for NASAH data is missed. Our objective was to analyze the rate of cerebral vasospasm (CVS)-dependent and CVS-independent delayed cerebral infarctions (DCI) and their influence to the clinical outcome after NASAH.

Method: Between 1999 and 2015 250 patients suffered from NASAH. CVS, DCI and outcome (according to the modified Rankin Scale at 6 months) were analyzed retrospectively. DCI was analyzed if it was associated with CVS (CVS-dependent DCI) or not (CVS-independent DCI). According to recent data, outcome and DCI analysis were stratified to Fisher 3 bleeding pattern (Fi3) or not (non-Fi3: including perimesencephalic SAH and Non-PM SAH without Fisher 3 blood distribution).

Results: Patients’ characteristics and outcome of perimesencephalic (PM) and non-PM SAH without Fisher 3 bleeding pattern were similar. CVS was identified significantly more often in the Fi3 group compared to non-Fi3 group (57% vs 14%). DCI occurs in 14% of patients, but significantly more often in Fi3 (43%) compared to non-Fi3 (9%). However, in both groups CVS-dependent (28% of patients with CVS had DCI) and CVS-independent DCI (11% of patients without CVS had DCI) occurred. Patients without CVS and without DCI (n=175) received the best outcome (mRS 0-2 in 94%), whereas favorable outcome rate was significantly reduced in any other group. Patients with CVS, but without DCI (n=39) had a favorable outcome in 77%. However 62% of the patients with CVS-independent DCI (n=21) achieved a favorable outcome and only 47% with CVS-dependent DCI (n=15). Interestingly, the Fi3 group had the highest rate of CVS-dependent DCI (26% of patients) and CVS-independent DCI (17%).

Conclusions: Patients with NASAH had CVS-dependent and CVS-independent DCI. In patients with NASAH w/o Fi3 blood distribution DCI occurs rarely (8%) and a favorable outcome can be achieved in 90%. CVS and DCI influenced patients’ outcome significantly. However, in contrast to aneurysmal SAH CVS-independent DCI occurs rarely (11%) and favorable outcome was not affected significantly in this subgroup (91% favorable outcome). Nonetheless, patients’ outcome was affected by CVS-dependent and CVS-independent DCI. Comparing the subgroups patients with CVS-dependent DCI had the worst outcome.