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[Cerebral blood flow in the determination of vasospasm and surgical decision]
1Service de Neurochirurgie, Hôpital Lariboisière, Paris.
The interest of C.B.F. studies performed on patients with subarachnoid haemorrhage is discussed on the basis of the literature and of our experience of 142 cases. C.B.F. results in basic condition are influenced by many factors which make its use very limited and especially during the first days after haemorrhage (J0-J3). However, the analysis of the evolution of C.B.F. values in the same patient and moreover the C.B.F. reactivity to acetazolamide are good indicators of the occurrence of a vasospasm; progressive drop of the C.B.F. or poor reactivity are generally observed before clinical signs of vasospasm. Our policy is therefore to decide the date of surgery according to C.B.F. values but only for patients planned for delayed surgery (after the 3rd day).
The interest of C.B.F. studies performed on patients with subarachnoid haemorrhage is discussed on the basis of the literature and of our experience of 142 cases. C.B.F. results in basic condition are influenced by many factors which make its use very limited and especially during the first days after haemorrhage (J0-J3). However, the analysis of the evolution of C.B.F. values in the same patient and moreover the C.B.F. reactivity to acetazolamide are good indicators of the occurrence of a vasospasm; progressive drop of the C.B.F. or poor reactivity are generally observed before clinical signs of vasospasm. Our policy is therefore to decide the date of surgery according to C.B.F. values but only for patients planned for delayed surgery (after the 3rd day).