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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Role of invasive neuromonitoring in good-grade subarachnoid haemorrhage patients

Invasives Neuromonitoring in gut gradigen Subarachnoidalblutungen

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  • presenting/speaker Michael Veldeman - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Walid Albanna - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Miriam Weiss - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Catharina Conzen - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Schmidt Tobias - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Henna Schulze-Steinen - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland; Universitätsklinikum RWTH Aachen, Operative Intensivmedizin, Aachen, Deutschland
  • Martin Wiesmann - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland; Universitätsklinikum RWTH Aachen, Operative Intensivmedizin, Aachen, Deutschland; Universitätsklinikum RWTH Aachen, Klinik für Neuroradiologie, Aachen, Deutschland
  • Hans Rainer Clusmann - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Gerrit A. Schubert - Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP113

doi: 10.3205/20dgnc399, urn:nbn:de:0183-20dgnc3996

Published: June 26, 2020

© 2020 Veldeman 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: In aneurysmal subarachnoid hemorrhage (SAH), good-grade patients (H&H Grade I-II) tend to have a more favorable prognosis. Nonetheless, a relevant proportion of patients may still develop delayed cerebral ischemia (DCI) and worsening of outcome. If secondary deterioration occurs, invasive neuromonitoring (INM) may help to identify additional waves of DCI events and guide treatment.

Methods: We performed a prospective cohort analysis of all good-grade SAH patients referred to a single tertiary care center between 2010 and 2018. A total of 135 patients were enrolled in this observational trial. The cohort was separated into two groups, one before (pre-INM; n=60) and one after the introduction of invasive neuromonitoring in 2014 (post-INM; n=75). Secondary worsening prohibiting neurological examination occurred in 26 cases in the pre-INM group and in 28 cases in the post-INM group. In the latter group, patients received INM with either parenchymal oxygen saturation measurement (ptiO2), cerebral microdialysis (CMD) or both.

Results: There was a significant reduction in the rate of silent infarction after the introduction of INM (15.0 % vs. 4.0% p=0.026), with lower rates of overall DCI related infarctions and overall DCI related mortality, though the difference was not statistically significant (20.0% vs. 13.3%; p=0.297; 14.6% vs. 10.6%; p=0.265). In patients with secondary deterioration, the rate of favorable outcome was higher in the post-INM group (85.2% vs. 68.4%; p=0.252), but the difference was not statistically significant.

Conclusion: The majority of good-grade SAH patients eventually recover with favorable outcome. However, in patients with secondary deterioration, invasive neuromonitoring may help to guide DCI treatment and reduce the rate of silent infarction.