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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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Quantitative Assessment of the Subarachnoid Compartment in Correlation with the Development of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

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  • Moritz Scherer - Heidelberg University Hospital, Heidelberg, Deutschland
  • Lars Wessels - Berlin, Deutschland
  • Jin-on Jung - Heidelberg, Deutschland
  • Markus Möhlenbruch - Universitätsklinikum Heidelberg, Abteilung für Neuroradiologie, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Neurochirurgie, Heidelberg, Deutschland
  • Klaus Zweckberger - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, 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. DocDI.27.07

doi: 10.3205/17dgnc344, urn:nbn:de:0183-17dgnc3448

Published: June 9, 2017

© 2017 Scherer 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: With the traditional Fischer grade often being inconclusive in today’s multislice CT, imaging surrogates to evaluate the risk of cerebral vasospasm (VS) in aneurysmal subarachnoid (SAH) hemorrhage are still ill-defined. This study aimed to evaluate if quantitative measures of the subarachnoid compartment including hemorrhage and cerebrospinal-fluid (CSF) volumes correlate with the development of VS in SAH.

Methods: Over a 5-year period, 129 consecutive SAH-cases with repeat angiography taken on mean day 7±3 after ictus to clear clinical delayed cerebral ischemia (DCI) were retrospectively identified. Computer-assisted volumetric analysis was performed for SAH and CSF using an automatic segmentation tool on initial (<24h) CT scan after ictus. VS evident on repeat angiography after SAH defined primary outcome and regression analysis was performed for volumetric measures.

Results: Repeat angiography showed VS in 107 patients while VS was absent in 22 cases. Median Fischer grade was 4 (range 1-4, p=0.49) in both groups. SAH-grade (WFNS) showed a trend towards higher median values in patients with VS (3 vs. 2.5, range 1-5, p=0.06, respectively). Method of aneurysm occlusion (52 clipping vs. 74 coiling) had no association with VS (p=1.0). Patients with VS exhibited significantly greater clot volume and reduced CSF volume in the subarachnoid compartment compared to patients without VS (SAH: 34.0±30.0ml vs. 17.8±19.5ml, p<0.05 and CSF: 63.2±31.2ml vs. 90.5±61.7ml, p<0.01, respectively). Odds ratio (OR) to develop VS was increased 6-fold for patients with a SAH/CSF ratio above 0.25 (OR=6.1 95% C.I. 2.2 – 16.4, p<0.001).

Conclusion: Besides SAH volume, spare CSF had a strong association with VS, while Fischer grade failed to discriminate VS from non-VS patients. SAH/CSF ratio could serve as a promising surrogate for image-based risk-stratification for VS. This will help to customize neuromonitoring measures in patients at risk for VS after SAH. Clinical applicability and validity of SAH/CSF ratio has to be evaluated in future prospective series.