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Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage: A Matched Cohort Study
Roland Roelz1, Volker A Coenen2, Christian Scheiwe2
1From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.). roland.roelz@uniklinik-freiburg.de.
Insights
This study introduces stereotactic catheter ventriculocisternostomy (STX-VCS) and lavage therapy to prevent delayed cerebral infarction (DCI) after subarachnoid hemorrhage. The novel intervention significantly reduced DCI and mortality rates, improving patient outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Delayed cerebral infarction (DCI) is a significant cause of poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH).
- Current preventative strategies for DCI have limitations.
- A novel intervention combining stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy was developed.
Purpose of the Study:
- To evaluate the safety and efficacy of STX-VCS and lavage therapy in preventing DCI.
- To compare outcomes of patients treated with STX-VCS to matched controls.
Main Methods:
- A cohort of 20 high-risk aSAH patients received STX-VCS and lavage therapy.
- Sixty matched controls were selected based on age, sex, aneurysm treatment, and Hunt and Hess grade.
- Conditional logistic regression was used to assess the association between STX-VCS and DCI, mortality, and modified Rankin Scale (mRS) scores.
Main Results:
- STX-VCS procedures were performed without surgical complications.
- DCI occurred in 15% of STX-VCS patients versus 42% of controls (OR 0.15).
- Mortality was 5% in the STX-VCS group compared to 33% in controls (OR 0.08), with 60% achieving favorable mRS scores versus 35% in controls.
Conclusions:
- STX-VCS combined with lavage therapy is a feasible and safe intervention for high-risk aSAH patients.
- This novel approach shows promising results in reducing DCI and mortality.
- The intervention may lead to improved neurological outcomes in patients with aSAH.
Background And Purpose:
Delayed cerebral infarction (DCI) is a major source of morbidity and mortality after aneurysmal subarachnoid hemorrhage. We report a novel intervention-stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy-for DCI prevention. Outcomes of 20 consecutive patients are compared with 60 matched controls.
Methods:
On the basis of individual treatment decisions, STX-VCS was performed in 20 high-risk aneurysmal subarachnoid hemorrhage patients admitted to our department between September 2015 and October 2016. Three controls matched for age, sex, aneurysm treatment method, and admission Hunt and Hess grade were assigned to each case treated by STX-VCS. DCI was the primary outcome. Mortality and mRS at rehabilitation discharge were secondary outcome parameters. The association between STX-VCS and DCI, mortality, and mRS was assessed by conditional logistic regression.
Results:
Stereotactic procedures were performed without surgical complications. Continuous cisternal lavage was feasible in 17 of 20 patients (85%). One adverse event because of cisternal lavage was without sequelae. DCI occurred in 25 of 60 (42%) controls and 3 of 20 (15%) patients with STX-VCS (odds ratio, 0.15; 95% confidence interval, 0.04-0.64). Mortality occurred in 20 of 60 (33%) controls and 1 of 20 (5%) patients with STX-VCS, respectively (odds ratio, 0.08; 95% confidence interval, 0.01 - 0.66). Favorable outcome (mRS≤3) at rehabilitation discharge was observed in 12 of 20 patients with STX-VCS (60%) versus 21 of 60 (35%) matched controls (odds ratio, 0.26; 95% confidence interval, 0.8-0.86).
Conclusions:
STX-VCS was feasible and safe in patients with severe aneurysmal subarachnoid hemorrhage. Initial results indicate that DCI and mortality can be reduced, and neurological outcome may be improved with this method.
