Article
Natural volume time course of the middle cerebral artery in patients with aneurysmal subarachnoid haemorrhage
Analyse des zeitlichen Verlaufs des Volumens der Arteria cerebri media in Patienten mit Subarachnoidalblutung
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Authors
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Tobias Fabian Pantel
- University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Deutschland
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Patrick Czorlich
- University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Deutschland
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Andreas Fröhlich
- University Medical Center Hamburg-Eppendorf, Department of Neroradiology, Hamburg, Deutschland
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Manfred Westphal
- University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Deutschland
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Axel Neulen
- University Medical Centre, Johannes Gutenberg University Mainz, Department of Neurosurgery, Mainz, Deutschland
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Lasse Dührsen
- University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Posthemorrhagic erebral vasospasm is one of the major contributors to delayed cerebral ischemia (DCI) which frequently causes neurological deterioration in SAH patients. A major target during intensive care treatment is monitoring of vasospasm with transcranial Doppler sonography (TCD), CT-angiography (CT-A) or digital subtraction angiography (DSA). Previous studies defined volume thresholds below which impaired perfusion is unlikely. Up to now no volumetric data on time course of the middle cerebral artery (MCA) volume during the initial phase after subarachnoid hemorrhage are available hence we set out to investigate this element.
Methods: We retrospectively identified patients admitted with aneurysmal SAH to our neurosurgical department with or without clinically DCI during therapy. Patients were routinely monitored by serial TCD. Volumetric vessel parameters of MCA segments were analyzed from CTA using a standardized protocol with Amira® software. Volumetric parameters were classified according predefined time points to illustrate the volume course in patients with and without DCI for the first 21 days after ictus.
Results: We identified 20 patients with the diagnosis of aneurymal SAH and serial assessment with CTA as well as TCD. Four patients developed DCI. 67 CT-A (DCI n=25, no DCI n=42) got completely analyzed. MCA volume at ictus was 8.334 ± 2.957 (no DCI) vs. 9.372 ± 1.761 (DCI) µl/mm and during day 1-3 9.535 ± 3.047 (no DCI) vs. 4.551 ± 0.993 (DCI) µl/mm. During day 4-10 and day 11-21 MCA volume was 7.778 ± 2.495 (no DCI) vs. 7.013 ± 1.956 (DCI) µl/mm and 7.122 ± 3.596 (no DCI) vs. 7.735 ± 2.608 (DCI) µl/mm. Statistically significant difference for MCA volume among patients with and without DCI was seen during day 1-3 (p<0.05).
Conclusion: To the best of our knowledge this study for the first time presents a neuroradiological time course of MCA volume in patients with aneurysmal SAH. Vessel volumes decrease over the first 21 days after ictus in all patients which indicates a general higher vessel tonus after SAH. During day 1 and 3 MCA volume was statistically significantly lower in the DCI cohort indicating a highly relevance of the initial days after ictus for developing DCI. These findings were concordant with corresponding TCD data documenting increased flow velocities during this time period in patients with developing DCI.
