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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Prophylaxis, diagnosis, and therapy of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage in Germany: a nation-wide survey

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  • Silvia Hernandez Duran - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - 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. DocMi.19.04

doi: 10.3205/17dgnc495, urn:nbn:de:0183-17dgnc4954

Published: June 9, 2017

© 2017 Hernandez Duran 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

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Objective: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Delayed cerebral ischemia (DCI) is one of the main contributors to poor outcome after aSAH. While several studies have assessed the use of nimodipine and other medications in aSAH, no consensus standard currently exists for the prophylaxis, diagnosis or treatment for DCI in the clinical setting.

Methods: We conducted a nation-wide, Internet-based survey of German tertiary centers treating patients with aSAH. Our goal was to assess how DCI is prevented, diagnosed, and treated in Germany in patients with aSAH.

Results: A total of 40 tertiary centers were included in the analysis. All of them (40/40, 100%) use nimodipine for DCI prophylaxis in aSAH. The majority of these centers administer nimodipine for 21 days (19/40, 47.5%), through both oral and intravenous routes (24/40, 60%). In 27/40 centers (67.5%), nimodipine is interrupted when high catecholamine doses are needed. Specific cut-off values of catecholamine doses for nimodipine interruption were heterogeneous. The majority of centers (39/40, 97.5%) use transcranial Doppler (TCD) to monitor vasospasm. Other methods employed include CT-angiography (CTA) (20/40, 50%), CT-perfusion (CTP) (24/40, 60%), digital subtraction angiography (DSA) (24/40, 60%), and brain tissue oxygenation (17/40, 42.5%). However, there is no homogeneous parameter dictating when these diagnostic tools are used. Pathological TCD-values and clinical deterioration were the most common criteria that indicated further DCI work-up; in 37.5%, these criteria lead to CTP, while in 45% to CTA, and in 37.5% to DSA. Treatment of DCI/vasospasm included Triple-H (37/40, 92.5%), medical dilation (28/40, 70%), and mechanical dilation (24/40, 60%).

Conclusion: Our survey reveals a large heterogeneity in the prophylaxis, diagnosis, and therapy of DCI in patients with aSAH in Germany. This illustrates the need for an established standard of care in the management of this complex condition.