Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage

Addis, Alberto; Baggiani, Marta; Citerio, Giuseppe

doi:10.1007/s12028-023-01752-y

Cited by 14 publications

(5 citation statements)

References 78 publications

(95 reference statements)

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“…In recent years, ICP monitoring has achieved good results in the application of cerebrovascular disease and brain tumor operation. Studies have shown that ventricular drainage combined with ICP monitoring can reduce cerebral vasospasm and hydrocephalus after ruptured aneurysm operation and reduce the incidence of adverse reactions (Konovalov et al, 2021;Addis et al, 2023). In addition, stable hemodynamic parameters are also the key to ensure the success of craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

Li,

He,

et al. 2024

Int. J. Morphol.

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Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P<0.05). At 1 day after operation, in monitoring group, GCS score was remarkably higher while NIHSS score was lower than that of control (P<0.05). At 3 months of postoperative follow-up, 5 cases were lost to follow-up in control group and 4 cases were lost in monitoring group. Excellent and good rate of GOS grading in control group was 89.65 % (52/58), and 93.22 % (55/58) in monitoring group. In addition, the excellent and good rate of mRS grading in control group was 91.38 % (53/58), and 94.92 % (56/58) in monitoring group, there was no remarkable difference in the excellent and good rate of GOS and mRS grading between the two groups at 3 months after operation (P>0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

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Section: Discussionmentioning

confidence: 99%

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

Li,

He,

et al. 2024

Int. J. Morphol.

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“…Hypertension, characterized by excessive blood pressure in the arteries, has a complex mechanistic impact on the development and progression of aneurysms (Addis et al, 2023;Rega et al, 2023;Sharma et al, 2023). Several potential correlates have been identified.…”

Section: Discussionmentioning

confidence: 99%

Gut microbiome and metabolome in aneurysm rat with hypertension after ginsenoside Rb1 treatment

Zeng,

Wang,

et al. 2023

Front. Pharmacol.

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Introduction: Hypertension is a well-known risk factor for aneurysms, as high blood pressure can worsen the development and rupture of aneurysms. Ginsenoside, derived from ginseng and widely used in traditional herbal medicine, is believed to have antihypertensive properties. Recent research has also shown a connection between gut microbiota and various diseases, including hypertension. However, the relationship between ginsenosides, gut microbiota, blood pressure, and intracranial aneurysms needs further exploration.Methods: In this study, a rat model was used to investigate the effects of ginsenosides on both blood pressure and intracranial arteries. Comparative analysis was conducted, and 16S rRNA sequencing was employed to identify marker genera within the gut microbiota. Metabolites were also analyzed to uncover potential mediators of blood pressure regulation.Results and Discussion: The results of this study revealed that ginsenosides, particularly ginsenoside Rb1, demonstrated positive effects in reducing both blood pressure and the development of intracranial aneurysms in rats. Furthermore, the analysis of gut microbiota showed that certain genera, including Clostridium, Roseburia, Ruminococcus, and Treponema, were significantly influenced by ginsenoside treatment. Several metabolites, such as behenic acid, N-Acetylserotonin, Prostaglandin F2a, and Vitamin D2, were also detected, all of which play a role in regulating blood pressure. These findings provide valuable insights into the potential benefits of ginsenosides in hypertension and atheroma development. Furthermore, they suggest a possible link between ginsenosides, gut microbiota, and blood pressure regulation. Further research is needed to fully understand the mechanisms underlying these effects and to determine the clinical implications for treating hypertension and reducing the risk of aneurysm development.

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“…The practice of intracranial pressure (ICP) monitoring in patients with aSAH remains a matter of debate due to the absence of high-level evidence tailored to this condition [ 68 ] (Fig. 2 ).…”

Section: Intracranial Complicationsmentioning

confidence: 99%

“…Elevated ICP in aSAH may arise primarily from hydrocephalus (30%), intracerebral haemorrhage (ICH), and early or delayed global cerebral oedema (GCO) (8–12%) [ 68 , 80 ]. Less common causes include subdural hematoma, cerebral infarction, and extracranial factors.…”

Section: Intracranial Complicationsmentioning

confidence: 99%

Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist

Robba,

Busl,

Claassen

et al. 2024

Intensive Care Med

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Aneurysmal subarachnoid haemorrhage (aSAH) is a rare yet profoundly debilitating condition associated with high global case fatality and morbidity rates. The key determinants of functional outcome include early brain injury, rebleeding of the ruptured aneurysm and delayed cerebral ischaemia. The only effective way to reduce the risk of rebleeding is to secure the ruptured aneurysm quickly. Prompt diagnosis, transfer to specialized centers, and meticulous management in the intensive care unit (ICU) significantly improved the prognosis of aSAH. Recently, multimodality monitoring with specific interventions to correct pathophysiological imbalances has been proposed. Vigilance extends beyond intracranial concerns to encompass systemic respiratory and haemodynamic monitoring, as derangements in these systems can precipitate secondary brain damage. Challenges persist in treating aSAH patients, exacerbated by a paucity of robust clinical evidence, with many interventions showing no benefit when tested in rigorous clinical trials. Given the growing body of literature in this field and the issuance of contemporary guidelines, our objective is to furnish an updated review of essential principles of ICU management for this patient population. Our review will discuss the epidemiology, initial stabilization, treatment strategies, long-term prognostic factors, the identification and management of post-aSAH complications. We aim to offer practical clinical guidance to intensivists, grounded in current evidence and expert clinical experience, while adhering to a concise format. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07387-7.

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Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage

Cited by 14 publications

References 78 publications

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

Gut microbiome and metabolome in aneurysm rat with hypertension after ginsenoside Rb1 treatment

Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist

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