Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea

Statins are drugs used to control cholesterol disorders and prevent cardiovascular diseases. Their denominated pleiotropic effects have demonstrated a broad action spectrum that might profit some neurological and neurosurgical diseases. These effects are correlated to dose and kind of statin. We accomplished a systematic review in PubMed and MEDLINE about studies of statins and main neurosurgical diseases. If statins are administered after subarachnoid hemorrhage, a significant lower incidence of vasospasm as well as delayed ischemic deficits and decreased mortality could be found; the results of a large multicenter trial are expected. In other complex diseases as intracerebral hemorrhage or traumatic brain injury, the evidence for positive effects of a treatment with statin increased. Additionally, promising experimental results indicate that high statin doses are able to promote cell death in tumor cells, especially in gliomas. Moreover, experimental and observational studies suggest the ability of statins to modulate the immune system, by that they can reduce incidence and severity of sepsis. The origin of these multiple effects from neuroprotection to tumoral apoptosis is not totally explained so far. Recent data in literature are discussed in this review. More trials in humans are urgently required to finally determine if statins could contribute to the current management of neurosurgical diseases.

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The role of statins in neurosurgery

Tapia-Pérez

Sánchez-Aguilar

Schneider

2010

Neurosurg Rev

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Diagnostic Sensitivity of Plasma Endothelin-1 for Cerebral Vasospasm After Subarachnoid Hemorrhage, a Multicentre Double-Blind Study

Bellapart

Nasrallah

Winearls³

et al. 2021

J Intensive Care Med

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The purpose of this study is to establish the diagnostic sensitivity of Endothelin-1 for risk stratification and screening of clinical vasospasm after subarachnoid hemorrhage. This is a multicentre, observational study, correlating daily blood Endothelin-1 with clinical variables. Binary logistic regression used to examine if Endothelin-1 levels could be used to predict clinical vasospasm. Bivariate modelling used to explore associations between patient characteristics and vasospasm. A Receiver Operating Curve used to explore cut-off values for Endothelin-1. Sensitivity and specificity was used to validate the cut-point found in the pilot study. A total of 96 patients were enrolled over two years. Median Endothelin-1 was higher for patients who experienced clinical vasospasm except for day-5, where median endothelin for patients without vasospasm was higher (3.6 IQR = 5.3), compared to patients with vasospasm (3.3 IQR = 8.5) although differences were not significant. The Receiver Operating Curve analysis confirmed that day-5 Endothelin-1 was not a good indicator of vasospasm, with an area under the curve of 0.506 (95% CI: 0.350-0.663, p = 0.938). The levels of Endothelin-1 in blood do not discriminate patients who may develop symptomatic vasospasm. The high variability in Endothelin-1 levels, aligns with the pathophysiological variability of most biomarkers, decreasing their ability to predict a clinical event.

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Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

Hofmann

Marbacher

Jakob

et al. 2011

ISRN Vascular Medicine

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Background. Outcome after endovascular versus surgical treatment of ruptured aneurysms is still controversial. The aim of this study was to analyze the incidence of cerebral vasospasm (CVS), outcome, and quality of life in patients undergoing endovascular or surgical treatment. Methods. This single-center prospective study included all patients undergoing aneurysm occlusion over a one-year period. All patients underwent postinterventional CT scan, TCD, and angiography on day 9 ± 2 . Outcome (Barthel Index, NIHSS, mRS, MMSE) was evaluated at 6 and 12 weeks. Quality of life (EuroQoL, SF-12) was assessed at 6 months. Results. A total of 66 patients were included. The overall mortality due to CVS was 9.9%, and higher in the surgical (14.6%) than in the endovascular group (4%). The incidence of symptomatic (29.2% versus 24%) and angiographic (70.7% versus 52%) CVS was not statistically significant different between the two groups. No differences in outcome or quality of life (SF-12) could be demonstrated. Conclusions. The outcome and quality of life of patients undergoing endovascular or surgical treatment seems not to significantly differ if demographic, radiological, and intensive care parameters are similar. A trend toward lower incidence of CVS in patients undergoing endovascular treatment was observed.

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Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea

Cited by 3 publications

References 85 publications

The role of statins in neurosurgery

The role of statins in neurosurgery

Diagnostic Sensitivity of Plasma Endothelin-1 for Cerebral Vasospasm After Subarachnoid Hemorrhage, a Multicentre Double-Blind Study

Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

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