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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Stellate ganglion block – bedside cerebral blood flow velocity reduction for vasospasm after aneurysmal subarachnoid haemorrhage

Stellate ganglion block – Bedside Technik zur Reduktion des cerebralen Blutfluss bei Vasospasmus

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  • presenting/speaker Christopher Wendel - Klinikum Stuttgart, Katharinenhospital, Neurochirurgische Klinik, Stuttgart, Deutschland
  • Hans Henkes - Klinikum Stuttgart, Katharinenhospital, Neuroradiologische Klinik, Stuttgart, Deutschland
  • Jan-H. Schiff - Klinikum Stuttgart, Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Stuttgart, Deutschland
  • Oliver Ganslandt - Klinikum Stuttgart, Katharinenhospital, Neurochirurgische Klinik, Stuttgart, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV203

doi: 10.3205/22dgnc197, urn:nbn:de:0183-22dgnc1976

Published: May 25, 2022

© 2022 Wendel 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: To assess the efficacy of SGB in the treatment of CV following aSAH.

Following aneurysmal subarachnoid hemorrhage (aSAH) delayed cerebral ischemia can occur from cerebral vasospasm (CV) after 3-14 days. Despite medical treatment, 1 of 3 patients suffers a persistent neurological deficit. For bedside detection transcranial Doppler (TCD) ultrasonography is performed daily. An increase in cerebral blood flow velocity (CBFV) over 120cm/s or a rise of 40cm/s within 24 hours is highly suggestive of vasospasm. Stellate ganglion block (SGB) is suggested to reduce CBFV in persistent CV despite maximum standard therapy.

Methods: The data were collected from records of patients treated between 2013 and 2021. Patients with SGB following aSAH were included, when CBFV was ≥ 120 cm/sec and if either a focal neurological deficit or reduced consciousness was noted, despite having received medical treatment and blood pressure management. The SGB was performed on the brain side with highest CBFV. SGBs were done with 8-10 ml ropivacaine 0.2% either with or without additional clonidine 150µg. CBFV changes on the ipsi- (and contralateral) side of the brain were monitored with TCD ultrasonography two and 24 hours after SGB.

Results: 42 patients (aged 17.5 to 69.7 years) (Female 23: 19 Male) received 88 SGBs in two territories (left 43: 45 right side). Median WFNS and Fisher Score was 4 at admission.

Mean absolute CBFV in MCA before SGB was 168.0 ± 32.6 cm/s and reduced to 135.51 ± 37.7 cm/s two hours post SGB (p=0.04) and after 24 hours 140.1 ± 38.3 cm/s (p=0.41). The addition of clonidine (n=44) showed no significance in CBFV reduction. Coiling (n=24), clipping (n=16), WFNS or Fisher Score showed no significant correlation for CBFV reduction. Mean length of intensive care unit stay was 24.2 days, median Glasgow Outcome Scale (GOS) at discharge was 3 and at 6 month follow up GOS 4.

Conclusion: SGB can be used bedside, leads to replicable reduction in CBFV in CV and has a potential benefit in the management of aSAH patients with deleterious CV.

Figure 1 [Fig. 1], Figure [Fig. 2]