Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage

Roelz, Roland; Coenen, Volker A.; Scheiwe, Christian; Niesen, Wolf‐Dirk; Egger, Karl; Csok, Istvan; Kraeutle, Rainer; Jabbarli, Ramazan; Urbach, Horst; Reinacher, Peter C.

doi:10.1161/strokeaha.117.018397

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…Small trials of aSAH clearance via other direct clearance methods have shown decreased rates of DCI and improved outcomes. A small, matched cohort trial of direct cisternal lavage with urokinase with the objective of SAH clearance showed decreased rates of DCI and mortality with a trend towards decreased shunt dependence and improvement in functional outcomes at time of rehabilitation discharge [ 222 ]. The trial did not assess for efficacy of SAH clearance but mentioned that 9 of 20 patients with early CTs exhibited near complete resolution of SAH.…”

Section: Clinical Evidence Supporting Early and Total Evacuation/treatment Of Intracranial Hemorrhagementioning

confidence: 99%

When the Blood Hits Your Brain: The Neurotoxicity of Extravasated Blood

Stokum

Cannarsa

Wessell

et al. 2021

IJMS

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Hemorrhage in the central nervous system (CNS), including intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and aneurysmal subarachnoid hemorrhage (aSAH), remains highly morbid. Trials of medical management for these conditions over recent decades have been largely unsuccessful in improving outcome and reducing mortality. Beyond its role in creating mass effect, the presence of extravasated blood in patients with CNS hemorrhage is generally overlooked. Since trials of surgical intervention to remove CNS hemorrhage have been generally unsuccessful, the potent neurotoxicity of blood is generally viewed as a basic scientific curiosity rather than a clinically meaningful factor. In this review, we evaluate the direct role of blood as a neurotoxin and its subsequent clinical relevance. We first describe the molecular mechanisms of blood neurotoxicity. We then evaluate the clinical literature that directly relates to the evacuation of CNS hemorrhage. We posit that the efficacy of clot removal is a critical factor in outcome following surgical intervention. Future interventions for CNS hemorrhage should be guided by the principle that blood is exquisitely toxic to the brain.

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Section: Clinical Evidence Supporting Early and Total Evacuation/treatment Of Intracranial Hemorrhagementioning

confidence: 99%

When the Blood Hits Your Brain: The Neurotoxicity of Extravasated Blood

Stokum

Cannarsa

Wessell

et al. 2021

IJMS

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“…A plethora of medical treatment options to attenuate vasospasm, such as statins, corticosteroids, clazosentan, milrinone, magnesium sulfate, fasudil hydrochloride, cilostazol and edaravone, has been tested in both, experimental and clinical settings; however, with exemption of one single agent, the calcium channel antagonist nimodipine, no systemic medical therapy has shown a robust and reproducible effect on functional outcome in these patients [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Therefore, in most centers, enteral administration of nimodipine is part of the standard treatment protocol in order to prevent vasospasm; however, different routes of administration including parenteral intravenous administration, intrathecal administration via external ventricular drainage and intracisternal administration via stereotactically placed catheters have been used and tested; yet, these alternative methods of administration remain to be of experimental character [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Furthermore, nimodipine has been administered intraarterially as a measure of local vasodilative rescue therapy in cases of symptomatic delayed cerebral vasospasm [ 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia

Walter

Grutza

Möhlenbruch

et al. 2022

JCM

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The effect of the intraarterial administration of nimodipine as a rescue measure to treat delayed vasospasm after aSAH remains understudied; therefore, we evaluated its effect on short- and long-term functional and neuropsychological outcomes after aSAH. In this prospective observational study, a total of 107 consecutive patients treated for aSAH of WFNS grades I–V were recruited. At follow-up visits 3-, 12- and 24-months after the hemorrhage, functional outcome was assessed using the Extended Glasgow Outcome (GOSE) and modified Rankin (mRS) scales, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). The outcome of patients, who had received rescue therapy according to the local standard treatment protocol (interventional group, n = 37), and those, who had been treated conservatively (conservative group, n = 70), were compared. Even though significantly more patients in the interventional treatment group suffered from high-grade aSAH (WFNS Grades IV and V, 54.1% vs. 31.4%, p = 0.04) and required continuous drainage of cerebrospinal fluid at discharge (67.7% vs. 37.7%, p = 0.02) compared to the control group, significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE > 4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p < 0.001 and p = 0.01 for the interventional and control group, respectively). Thereafter, group differences were no longer significant. While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 29.2%, p = 0.04 and 0.05, respectively) and were unable to work (5.9% vs. 38.1%, p = 0.03 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long-term follow-up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint. In conclusion, despite initially being significantly more impaired, patients treated with intraarterial administration of nimodipine reached the same functional and neuropsychological outcomes at medium- and long-term follow-up as conservatively treated patients suggesting a potential beneficial effect of intraarterial nimodipine treatment for delayed vasospasm after aSAH.

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“…New treatment strategies are needed and have to be carefully evaluated [7,8]. Just one example indicating the potential of machine learning in clinical neuroradiology.…”

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confidence: 99%