Cerebral vasospasm following aneurysm rupture. A protocol for therapy and prophylaxis

Area of Science:

• Neurosurgery
• Neurology
• Vascular Surgery

Background:

• Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms can lead to vasospasm, a major cause of morbidity and mortality.
• Early surgical intervention is often necessary, but the risk of vasospasm complicates patient management.

Purpose of the Study:

• To evaluate the impact of aggressive volume management and preoperative angiography on the incidence and timing of vasospasm following aneurysm surgery.
• To compare outcomes between patients managed with standard care versus an aggressive management protocol.

Main Methods:

• Retrospective analysis of 195 patients with ruptured intracranial aneurysms and no significant hematomas.
• Group 1 (n=121): Standard surgical timing (10 days-2 weeks post-SAH) without repeat angiography or specific hemodynamic management.
• Group 2 (n=74): Aggressive volume replacement, preoperative angiography at 2 weeks, with delayed surgery and prophylactic medication if vasospasm persisted.

Main Results:

• Clinical vasospasm occurred in 15% of Group 1, with over half postoperatively. Half of these were successfully treated.
• In Group 2, vasospasm incidence was similar but predominantly preoperative.
• Postoperative vasospasm was nearly eliminated in Group 2, with more effective treatment of preoperative vasospasm.

Conclusions:

• Aggressive maintenance of normal circulating blood volume combined with preoperative angiography and tailored surgical timing significantly reduces postoperative vasospasm.
• This management strategy improves the timing of vasospasm and enhances treatment efficacy, particularly for preoperative cases.
• The findings support a proactive approach to managing vasospasm in patients with ruptured intracranial aneurysms to minimize postoperative complications.