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Neurosurgical Review

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Open Access 01-12-2024 | Subarachnoid Hemorrhage | Research

Impact of ventriculo-cisternal irrigation on prevention of delayed cerebral infarction in aneurysmal subarachnoid hemorrhage: a single-center retrospective study and literature review

Authors: Motoyuki Umekawa, Gakushi Yoshikawa

Published in: Neurosurgical Review | Issue 1/2024

Abstract

Objective

The aim of this study was to evaluate the effectiveness of ventriculo-cisternal irrigation (VCI) in preventing vasospasms and delayed cerebral infarction (DCI) by washing out subarachnoid clots earlier after aneurysm surgery.

Methods

We retrospectively identified 340 subarachnoid hemorrhage (SAH) patients with ruptured intracranial aneurysms treated with postoperative VCI at our institution between December 2010 and January 2020. As VCI therapy, a ventricular drain/cisternal drain was placed during aneurysm surgery, and lactated Ringer’s solution was used for irrigation until day 4 of SAH, followed by intracranial pressure control at 5–10 cmH₂O until day 14.

Results

The median age was 65 years (interquartile range 52–75), with 236 female patients (69%). The World Federation of Neurosurgical Societies grade distribution was as follows: grade I or II, 175 patients (51%); grade III or IV, 84 (25%); and grade V, 81 (24%). With VCI management in all patients, total vasospasm occurred in 162 patients (48%), although the DCI incidence was low (23 patients [6.8%]). Major drainage-related complications were observed in five patients (1.5%). Early surgery, performed on SAH day 0 or 1, was identified as a preventive factor against DCI occurrence (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.07–0.67; P = 0.008), while additional surgery (4.76, 1.62–13.98; P = 0.005) and dyslipidemia (3.27, 1.24–8.63; P = 0.017) were associated with DCI occurrence.

Conclusion

Managing vasospasms with VCI after SAH is considered a safe and effective method to prevent DCI. Early surgery after SAH may be associated with a decreased risk of DCI with VCI therapy.

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Title: Impact of ventriculo-cisternal irrigation on prevention of delayed cerebral infarction in aneurysmal subarachnoid hemorrhage: a single-center retrospective study and literature review
Authors: Motoyuki Umekawa
Gakushi Yoshikawa
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Intracranial Hypertension
Aneurysm
Aneurysm
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-023-02241-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of ventriculo-cisternal irrigation on prevention of delayed cerebral infarction in aneurysmal subarachnoid hemorrhage: a single-center retrospective study and literature review

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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