The effect of surgery on the severity of vasospasm

Abstract

Intracranial aneurysm surgery performed between 4 and 12 days after subarachnoid hemorrhage (SAH) has been associated with an increased risk of delayed cerebral ischemia and poor outcome compared to surgery performed before or after this time. To investigate whether this increased risk is due to aggravation of vasospasm, the angiograms obtained before and after surgery in 56 patients operated on at various times after aneurysmal SAH were studied. Vasospasm was quantitated by measuring the diameters of intracranial arteries and expressed as the ratio of the diameters of the intracranial arteries to the diameter of the extracranial internal carotid artery. Aggressive surgical clot removal was not performed at surgery. To correct for differences in prognostic factors for vasospasm between patients operated on at different times after SAH, multiple regression analysis was performed using the arterial diameter ratio during vasospasm as the dependent variable and the prognostic factors for vasospasm, including the time of surgery, as independent variables. Equations predicting the severity of vasospasm could be generated using the clinical grade on admission, patient age, and preoperative arterial diameter ratio. The time of surgery had no effect on vasospasm. Cerebral infarction due to vasospasm developed in five (15%) of 34 patients operated on within 3 days after SAH and in four (20%) of 20 operated on between 4 and 12 days after SAH (p = 0.66). A good outcome for these two groups was achieved in 88% and 85%, respectively (p = 1.00). These results suggest that the timing of surgery does not affect the development of vasospasm. Any increased risk of cerebral ischemia associated with surgery performed between 4 and 12 days after SAH is due to factors other than aggravation of vasospasm.

Coil Embolization of Aneurysm Followed by Stereotactic Aspiration of Hematoma in a Patient with Anterior Communicating Artery Aneurysm Presenting with SAH and ICH

“…SAH results in decreased cerebral blood flow (CBF) and impairs autoregulatory function, which makes the brain more sensitive to retraction and to fluctuations in blood pressure and cardiac output 7) . So, initial endovascular coiling of aneurysm followed by hematoma evacuation through burrhole was considered reasonable treatment option for this patient and achieved a tolerable outcome.…”

Multivariate Analysis of Predictors of Cerebral Vasospasm Occurrence After Aneurysmal Subarachnoid Hemorrhage

“…Thus, younger patients are more likely to experience vasospasm than the others. 4,33 In this study, WFNS clinically low grades (I and II) were predictors of symptomatic vasospasm. Using the Hunt and Hess grades, Rabb et al 4 reported similar results, while in another study the Hunt and Hess clinical grades 30 were not found to be predictors of vasospasm.…”

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

“…Our findings are similar to those of other studies. For example, Yoshimoto and Kwak 49 and Macdonald et al, 28 who used DSA to diagnose CV, observed that a younger age is associated with a greater frequency of severe angiographic CV. Magge et al 29 also reported that the likelihood of severe vasospasm was greater with a younger age; patients with severe angiographic CV were on average 9 years younger than those with no CV.…”

“…Some studies have suggested that younger adults have a higher risk for developing CV. 28,29,49 There is no clear consensus, in part because CV can be diagnosed with different modalities and approaches, including digital subtraction angiography (DSA), CT angiography, transcranial Doppler (TCD) ultrasonography, and evaluation of clinical symptoms. The few published studies on CV in children have concluded that this group has a relatively high rate of CV diagnosed by angiography.…”