Patients with a GCS of 13-15 can be observed clinically (the expected outcome is very good). Comatose patients (GCS 3-8) with bilateral dilatation of the pupils should not be operated (very high mortality rate). If the GCS score is <13 and both pupils or only one are reactive to light and the midline shift<10 mm, surgery is indicated. If the midline shift is >10 mm and aSDH thickness>midline shift, surgery is also indicated. If in the same patient group midline shift>SDH thickness and ICP>40 mmHg, surgery is not indicated.

Objective. The aim of our prospective study was to investigate the applicability and the diagnostic value of near-infrared spectroscopy (NIRS) in SAH patients using the cerebral oximeter INVOS 5100C. Methods. Measurement of cerebral oximetry was done continuously after spontaneous SAH. Decrease of regional oxygen saturation (rSO2) was analyzed and interpreted in view of the determined intrinsic and extrinsic factors. Changes of rSO2 values were matched with the values of ICP, tipO2, and TCD and the results of additional neuroimaging. Results. Continuous measurement of rSO2 was performed in nine patients with SAH (7 females and 2 males). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients, NIRS measured constant and stable rSO2 values without relevant alterations. Special findings are demonstrated in 3 cases. Conclusion. Measurement of rSO2 with NIRS is a safe, easy to use, noninvasive additional measurement tool for cerebral oxygenation, which is used routinely during vascular and cardiac surgical procedures. NIRS is applicable over a long time period after SAH, especially in alert patients without invasive probes. Our observations were promising, whereby larger studies are needed to answer the open questions.

Magnetic resonance imaging of the brain and craniocervical region did not produce additional benefit for the detection of a bleeding source and the therapy administered for PM SAH and non-PM SAH (100% negative). The costs of this examination exceeded the clinical value. Despite the results of this study, MR imaging should be discussed on a case-by-case basis because rare bleeding sources are periodically diagnosed in cases of non-PM SAH. A second-look DS angiogram is necessary because aneurysmal hemorrhage occasionally produces PM SAH as well as non-PM SAH. Further prospective studies are needed to verify the authors' results in the future.

Patients with a GCS of 3-8 and two non-reactive pupils should not be operated. If one or both of the pupils are reactive, surgery should be performed irrespective of the GCS score, except in patients with translobar/transventricular wounds. Even if there are no clear contraindications to surgery, the outcome is expected to be poor in patients with a low GCS score, midline shift >10 mm, >2 bone fragments in the brain, and a bilobar, posterior fossa/brainstem or ventricular lesion and ICP >45 mmHg. When surgery is performed the wound and the missile or bone track should be debrided meticulously, the wound and dura should be closed in a watertight fashion and antibiotic prophylaxis as well as tetanus serum should be given.

Purpose We demonstrate clinical features, therapy and outcome of 14 patients with symptomatic spinal cavernous malformations (CM). Methods We retrospectively reviewed all patients who underwent microsurgical treatment of symptomatic spinal CM during the last decade in our department through an analysis of our database. Results We analyzed the data of 14 patients (11 females, 3 males) with symptomatic spinal CM in a range of 16-77 years (mean age 47.8 years). Seven patients (50%) experienced significant improvement of their symptoms rapidly after surgery. The remaining seven patients presented new non pre-existing complaints, which improved gradually with a favourable outcome at the last follow-up examination in six cases. Conclusion Microsurgical treatment under perioperative electrophysiological monitoring is justified to prevent severe neurofunctional deterioration in symptomatic spinal CM. Although some of the patients deteriorate after surgery, the symptoms are rapidly declining with a favourable outcome in majority of them.