Prevention of Vasospasm by Removal of Subarachnoid Blood in Early Operation

The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal ubarachnoid Hemorrhage

“…Its exact pathophysiologic mechanisms are not fully established and multi-factorial processes that contain oxygen free radicals, endothelin, vascular endothelial growth factor, arachidonic acid derivatives, lipid peroxidation, inactivation of nitrous oxide (NO), activation of protein kinase C system released from blood clots in the subarachnoid spaces and cisterns, are known to be related to cerebral vasospasm 3,10,12,14,15,19,21,22,24,31,[35][36][37] . There are numerous clinical studies that early surgical removal of blood clots and massive irrigation may reduce the risk of cerebral vasospasm 13,18,23) . However, it is difficult to remove completely blood colts in subarachnoid spaces and cisterns by surgery.…”

“…Moreover, the removal of the blood clots and irrigation of the cisterns performed by surgery have been reported to reduce the risk of cerebral vasospasm 13,18,23) . Nevertheless, it is difficult to completely remove all blood clots performed by Objective : Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage.…”

Intracranial arterial aneurysm--an update.

“…Early surgery also would make it safer to treat vasospasm aggressively with induced hypertension since the aneurysm would be secured. [18][19][20] It is true that the results reported by these very experienced Japanese neurosurgeons compare favorably with the best statistics available when total case-management morbidity and mortality are considered. The results, however, may not be as good in less experienced hands.…”

Symptomatic Cerebral Vasospasm after Surgical Ligation of Unruptured Aneurysms

“…10 However, subarachnoid blood alone is not an absolute predictor for cerebral vasospasm. Therefore, other influences must be present for cerebral vasospasm to occur and produce cerebral ischemia.…”

“…10,12,13 Uncomplicated clip ligation of cerebral aneurysm can progress to severe vasospasm, which may be an infrequent occurrence favoring female patients. In our patients it was lifethreatening and medically intractable requiring endovascular intervention.…”