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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Aneurysm treatment during cerebral vasospasm phase – A reason for concern?

Aneurysma-Behandlung Vasospasmusphase – Ein Grund zur Besorgnis?

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  • presenting/speaker Isabel Hostettler - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Nicole Lange - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Nina Schwendinger - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Samira Frangoulis - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Theresa Hirle - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Dominik Trost - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Kornelia Kreiser - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Maria Wostrack - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV008

doi: 10.3205/21dgnc008, urn:nbn:de:0183-21dgnc0080

Published: June 4, 2021

© 2021 Hostettler 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: Aneurysm surgery during the cerebral vasospasm (CVS) phase (days 4 to 14 after subarachnoid haemorrhage [aSAH]) is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct. We aimed to evaluate the risk of aSAH-specific complications and functional outcome in patients treated during CVS phase.

Methods: We retrospectively analysed a large, comprehensive retro- and prospectively collected database of all patients acutely admitted to our department due to an aSAH between March 2006 and March 2020. We conducted an univariable and multivariable logistic regression analysis in order to evaluate influencing factors on rebleeding, cerebral infarct, GOS at discharge and mortality. Vasospasm phase was defined as between 4-14 days after aSAH. Additionally, we assessed the rate of angiographic vasospasms on admission defined as the narrowing of the arterial diameter of more than 30%.

Results: We included a total of 853 patients. The majority of patients was female (66.6%), mean age was 57.3 years. Out of 853 included patients, 92 (10.8%) were treated during CVS phase. Overall, 312 (36.6%) underwent clipping and 541 (63.4%) endovascular treatment. Treatment during CVS phase was indeed significantly associated with cerebral infarct in the multivariable logistic regression analysis, unrelated to the nature of intervention (OR 2.42, 1.29-4.54 95% CI, p-value=0.006). However, patients treated during CVS phase did not have increased risk of unfavourable outcome measured by GOS on discharge. Additionally, they did not have a higher rate of rebleeding or mortality.

Conclusion: Treatment during CVS phase was significantly associated with a higher rate of cerebral infarcts as confirmed by imaging during the hospital stay. Despite this finding we could not confirm any significant effect on dichotomized GOS on discharge, rebleeding, or mortality. According to our experience, aneurysm treatment during CVS phase appears to be relatively safe and should therefore not be postponed due to the risk of rebleeding and subsequently devastating deterioration.