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Double hemispheric Microdialysis study in poor-grade SAH patients.

Ramon Torné1, Diego Culebras2, Gerard Sanchez-Etayo3

  • 1Neurological Surgery Department, Hospital Clinic of Barcelona, Barcelona, Spain. torne@clinic.cat.

Scientific Reports
|May 6, 2020
PubMed
Summary

Bilateral cerebral microdialysis (CMD) monitoring in subarachnoid hemorrhage (SAH) patients helps predict delayed cerebral ischemia (DCI). This strategy offers a more comprehensive assessment of metabolic crises compared to unilateral monitoring.

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Area of Science:

  • Neuroscience
  • Neurological Surgery
  • Critical Care Medicine

Background:

  • Delayed cerebral ischemia (DCI) affects 30% of subarachnoid hemorrhage (SAH) patients, posing significant challenges for prediction and prevention, especially in poor-grade cases (WFNS 4-5).
  • Cerebral microdialysis (CMD) provides real-time metabolic data but unilateral monitoring may miss diffuse brain repercussions following SAH.

Purpose of the Study:

  • To evaluate the utility, indications, and therapeutic implications of employing bilateral cerebral microdialysis (CMD) in poor-grade subarachnoid hemorrhage (SAH) patients.
  • To determine if bilateral CMD enhances the assessment of DCI risk and potential therapeutic interventions in SAH.

Main Methods:

  • Prospective collection of poor-grade SAH patients undergoing multimodal neuromonitoring.
  • Bilateral implantation of CMD probes for at least 48 hours, with aneurysm location and blood volume assessed via Angio-CT.
  • Definition of ischemic events: Lactate/Pyruvate ratio >40 and Glucose concentration <0.7 mmol/L.

Main Results:

  • 16 patients were monitored for 1725 hours, with ischemic events occurring during 15.1% of the time (260 hours).
  • Simultaneous bilateral ischemic events were infrequent (1.9% of monitored time).
  • A threshold of ≥7 ischemic events demonstrated high specificity (96.2%) and sensitivity (83.3%) for predicting DCI.

Conclusions:

  • Bilateral CMD is a safe and effective method for assessing DCI risk in SAH patients.
  • Metabolic crises in SAH occur bilaterally but not typically simultaneously, indicating unilateral monitoring may underestimate infarction risk.
  • Bilateral CMD provides a more complete picture, potentially improving therapeutic strategies for preventing DCI consequences.