gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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The intraventricular clot size and blood distribution within the ventricular system correlate with delayed cerebral ischemia after subarachnoid hemorrhage

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  • Vesna Malinova - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Bogdan Iliev - Georg-August-Universität, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Turab Gasimov - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.02.03

doi: 10.3205/17dgnc009, urn:nbn:de:0183-17dgnc0094

Published: June 9, 2017

© 2017 Malinova 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: Intraventricular hemorrhage (IVH) is a frequent condition in patients with aneurysmal subarachnoid hemorrhage (aSAH) associated with a higher incidence of hydrocephalus and poor outcome. While a higher amount of blood within the subarachnoid space leads to a higher incidence of delayed cerebral ischemia (DCI) after aSAH, the role of the amount and distribution of the intraventricular blood for the development of DCI is still not conclusive. The aim of this study was to evaluate the impact of the ventricular clot volume and its distribution on the incidence of DCI after aSAH.

Methods: A patient population with aSAH was retrospectively analyzed for the presence of DCI, defined as new infarction not related to aneurysm treatment. Volumetric measurements of the intraventricular clot based on the initial CT scan were done. For the classification of the amount of blood and its distribution a modification/simplification of the Graeb score (Morgan et al. 2013) was used (<30% ventricular blood related to the ventricle size=1 point, 30-70%=2 points, >70%=3 points; clot size score range 0-12). Furthermore, the blood distribution within the ventricles was documented; for each blood-filled ventricle 1 point was given (clot distribution score range 0-4). Then, we correlated the intraventricular clot size and clot distribution with the incidence of DCI.

Results: A total of 203 patients with aSAH were included in the analysis. The mean age was 55 years. A high initial Hunt & Hess grade was found in 33% (67/203) and a high modified Fisher grade in 91% (185/203) of the patients. 16% (33/203) of the patients developed a DCI. We found a statistically significant correlation of the intraventricular clot size with the incidence of DCI. The mean score in the DCI group was 2.4 vs. 4.8 in the group without DCI (linear regression, p=0.01). Furthermore, a significant correlation of the number of ventricles involved with the occurrence of DCI was detected, with a mean score of 1.6 in the DCI group vs. 3.7 in the group without DCI (linear regression, p=0.01).

Conclusion: The incidence of DCI increases with increasing clot size of intraventricular blood and with an increasing number of ventricles involved, in patients with aSAH and IVH. Thus, the intraventricular clot might be a possible treatment target (e.g. early and fast thrombolysis) in order to reduce the incidence of DCI after aSAH.