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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Altered CSF metabolomics after aneurysmal SAH and delayed cerebral ischemia

Liquor Metaboliten nach aneurysmatischer Subarachnoidalblutung und DCI/Vasospasmus

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  • presenting/speaker Wing Mann Ho - Medizin Uniklinik Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Alice Görke - Medizin Uniklinik Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Claudia Unterhofer - Medizin Uniklinik Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Raimund Helbok - Medizin Uniklinik Innsbruck, Neurologie, Innsbruck, Austria
  • Herbert Oberacher - Medizin Uniklinik Innsbruck, Gerichtsmedizin, Innsbruck, Austria
  • Claudius Thomé - Medizin Uniklinik Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Ondra Petr - Medizin Uniklinik Innsbruck, Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV221

doi: 10.3205/19dgnc238, urn:nbn:de:0183-19dgnc2384

Published: May 8, 2019

© 2019 Ho 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: The aim of this study was to investigate metabolite levels in cerebrospinal fluid (CSF) after aneurysmal subarachnoid hemorrhage (aSAH) and their correlation with delayed cerebral ischemia (DCI).

Methods: Eighty CSF samples of 16 patients with treated intracranial aneurysms were analyzed. The study population included patients undergoing emergency endovascular/microsurgical treatment for ruptured intracranial aneurysm (n=8). Control samples were collected intraoperatively at the beginning of the elective aneurysm surgery (n=8). The CSF samples after aSAH were consecutively collected by way of external ventricular drain (EVD) placement/intraoperatively, 6 hours later, and daily thereafter (day 1-10). The endogenous metabolites were analyzed with a targeted quantitative and quality controlled metabolites approach using the AbsoluteIDQ® p180 Kit. The results were pooled in 3 groups (controls / aSAH without DCI / aSAH with DCI). The occurrence of DCI was defined as symptomatic vasospasm, infarction attributable to vasospasm, or moderate-to-severe arterial narrowing seen on digital subtraction angiography.

Results: Most amino acid (AA) levels were increased in the CSF of patients with DCI (n=4) compared to controls (n=8; p<0.05), but did not differ from aSAH patients without DCI (n=4). Only proline, asymmetric dimethylarginine and kynurenine were significantly elevated in patients with DCI (p<0.05). In addition, the tyrosine/phenylalanine ratio was significantly lower (p<0.05), while the kynurenine/tryptophan ratio was substantially higher in DCI when compared to controls and aSAH without DCI (p<0.05). Moreover, several phosphatidylcholines concentrations were increased after aSAH and were associated with DCI (p<0.05).

Conclusion: Numerous significantly altered CSF-metabolites/compounds were found in patients with DCI related to aSAH. Their value as potential predictors deserve further investigation.