Spinal cord stimulation for cerebral vasospasm as prophylaxis

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) poses significant risks, including cerebral vasospasm and reduced cerebral blood flow (CBF).
• Standard treatments like hypervolemic therapy and nicardipine may be insufficient or poorly tolerated in some patients.
• Cerebral vasospasm following SAH can lead to severe neurological deficits.

Observation:

• This study investigated cervical spinal cord stimulation (SCS) as an adjunctive therapy in 10 patients with secured cerebral aneurysms (Hunt and Hess grade 3-4, Fisher group 3 SAH).
• Patients received preemptive SCS via a percutaneous lead post-aneurysm surgery, alongside standard hypervolemic therapy and nicardipine.
• Cerebral blood flow was assessed using xenon computed tomography and cerebral angiography.

Findings:

• Cervical spinal cord stimulation (SCS) significantly increased cerebral blood flow (CBF) in the middle cerebral artery distribution (p < 0.05).
• Four patients exhibited angiographic vasospasm, but none developed severe sequelae.
• Seven out of 10 patients achieved good or excellent outcomes, with no serious adverse effects reported from SCS.

Implications:

• Cervical spinal cord stimulation (SCS) may serve as a beneficial adjunctive therapy for preventing or treating cerebral vasospasm after subarachnoid hemorrhage (SAH).
• This approach offers a potential alternative or addition to current treatments, improving patient outcomes.
• Further research is warranted to confirm the efficacy and safety of SCS in a larger patient cohort.