Optimal intracranial pressure in patients with aneurysmal subarachnoid hemorrhage treated with coiling and requiring external ventricular drainage.
Cerebral infarction
Delayed cerebral ischemia
External ventricular drainage
Intracranial pressure
Vasospasm
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
25
02
2020
accepted:
19
05
2020
revised:
01
05
2020
pubmed:
28
5
2020
medline:
16
6
2021
entrez:
28
5
2020
Statut:
ppublish
Résumé
Optimal management of intracranial pressure (ICP) among aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) is controversial. To analyze predictors of delayed cerebral ischemia (DCI)-related cerebral infarction after aSAH and the influence of ICP values on DCI, we prospectively collected consecutive patients with aSAH receiving coiling and requiring EVD. Predictors of DCI-related cerebral infarction (new CT hypodensities developed within the first 3 weeks not related to other causes) were studied. Vasospasm and brain hypoperfusion were studied with CT angiography and CT perfusion (RAPID-software). Among 50 aSAH patients requiring EVD, 21 (42%) developed DCI-related cerebral infarction, while 27 (54%) presented vasospasm. Mean ICP ranged between 2 and 19 mmHg. On the multivariate analysis, the mean ICP (OR = 2, 95%CI = 1.01-3.9, p = 0.042) and the mean hypoperfusion volume on Tmax delay > 6 (OR = 1.2, 95%CI = 1.01-1.3, p = 0.025) were independent predictors of DCI. To predict DCI-related cerebral infarction, Tmax delay > 6 s presented the highest AUC (0.956, SE = 0.025), with a cutoff value of 18 ml showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95%CI = 69-98.8%), 86.2% (95%CI = 68.4-96%), 82.6% (95%CI = 65.4-92%), 92.5% (95%CI = 77-98%), and 88% (95%CI = 75-95%), respectively. The AUC of the mean ICP was 0.825 (SE = 0.057), and the best cutoff value was 6.7 mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95%CI = 48-89%), 62% (95%CI = 42-79%), 58% (95%CI = 44-70%), 75% (95%CI = 59-86%), and 66% (95%CI = 51-79%) for the prediction of DCI-related cerebral infarction, respectively. Among aSAH patients receiving coiling and EVD, lower ICP (< 6.7 mmHg in our study) could potentially be beneficial in decreasing DCI-related cerebral infarction. Brain hypoperfusion with a volume > 18 ml at Tmax delay > 6 s presents a high sensibility and specificity in prediction of DCI-related cerebral infarction.
Identifiants
pubmed: 32458277
doi: 10.1007/s10143-020-01322-2
pii: 10.1007/s10143-020-01322-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1191-1204Références
Abulhasan YB, Ortiz Jimenez J, Teitelbaum J, Simoneau G, Angle MR (2020) Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia. J Neurosurg 27:1–12
Albeck MJ, Borgesen SE, Gjerris F, Schmidt JF, Sorensen PS (1991) Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg 74:597–600
doi: 10.3171/jns.1991.74.4.0597
Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, de Rochemont RM, Singer OC, Bammer R, Saver JL (2016) Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol 79:76–89
doi: 10.1002/ana.24543
Alotaibi NM, Wang JZ, Pasarikovski CR, Guha D, Al-Mufti F, Mamdani M, Saposnik G, Schweizer TA, Macdonald RL (2017) Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus? Neurosurg Focus 43:E13
doi: 10.3171/2017.7.FOCUS17426
Brown RJ, Kumar A, Dhar R, Sampson TR, Diringer MN (2013) The relationship between delayed infarcts and angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 72:702–707 discussion 707-708
doi: 10.1227/NEU.0b013e318285c3db
Budohoski KP, Guilfoyle M, Helmy A, Huuskonen T, Czosnyka M, Kirollos R, Menon DK, Pickard JD, Kirkpatrick PJ (2014) The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 85:1343–1353
doi: 10.1136/jnnp-2014-307711
Chung DY, Leslie-Mazwi TM, Patel AB, Rordorf GA (2017) Management of external ventricular drains after subarachnoid hemorrhage: a multi-institutional survey. Neurocrit Care 26:356–361
doi: 10.1007/s12028-016-0352-9
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke C, Council on Cardiovascular R, Intervention, Council on Cardiovascular N, Council on Cardiovascular S, Anesthesia, Council on Clinical C (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43:1711–1737
doi: 10.1161/STR.0b013e3182587839
Cremers CH, van der Schaaf IC, Wensink E, Greving JP, Rinkel GJ, Velthuis BK, Vergouwen MD (2014) CT perfusion and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Cereb Blood Flow Metab 34:200–207
doi: 10.1038/jcbfm.2013.208
Dong L, Zhou Y, Wang M, Yang C, Yuan Q, Fang X (2019) Whole-brain CT perfusion on admission predicts delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. Eur J Radiol 116:165–173
doi: 10.1016/j.ejrad.2019.05.008
Fugate JE, Rabinstein AA, Wijdicks EF, Lanzino G (2012) Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a case report. Neurocrit Care 17:112–116
doi: 10.1007/s12028-012-9723-z
Lannes M, Teitelbaum J, del Pilar CM, Cardoso M, Angle M (2012) Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal neurological hospital protocol. Neurocrit Care 16:354–362
doi: 10.1007/s12028-012-9701-5
Macdonald RL, Higashida RT, Keller E, Mayer SA, Molyneux A, Raabe A, Vajkoczy P, Wanke I, Bach D, Frey A, Marr A, Roux S, Kassell N (2011) Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol 10:618–625
doi: 10.1016/S1474-4422(11)70108-9
Macdonald RL, Schweizer TA (2017) Spontaneous subarachnoid haemorrhage. Lancet 389:655–666
doi: 10.1016/S0140-6736(16)30668-7
Meng L, Hou W, Chui J, Han R, Gelb AW (2015) Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans. Anesthesiology 123:1198–1208
doi: 10.1097/ALN.0000000000000872
Ostergaard L, Aamand R, Karabegovic S, Tietze A, Blicher JU, Mikkelsen IK, Iversen NK, Secher N, Engedal TS, Anzabi M, Jimenez EG, Cai C, Koch KU, Naess-Schmidt ET, Obel A, Juul N, Rasmussen M, Sorensen JC (2013) The role of the microcirculation in delayed cerebral ischemia and chronic degenerative changes after subarachnoid hemorrhage. J Cereb Blood Flow Metab 33:1825–1837
doi: 10.1038/jcbfm.2013.173
Rabinstein AA, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM, Atkinson JL, Wijdicks EF (2004) Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 35:1862–1866
doi: 10.1161/01.STR.0000133132.76983.8e
Rabinstein AA, Lanzino G, Wijdicks EF (2010) Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol 9:504–519
doi: 10.1016/S1474-4422(10)70087-9
Rinkel GJ, Algra A (2011) Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 10:349–356
doi: 10.1016/S1474-4422(11)70017-5
Roos YB, de Haan RJ, Beenen LF, Groen RJ, Albrecht KW, Vermeulen M (2000) Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands. J Neurol Neurosurg Psychiatry 68:337–341
doi: 10.1136/jnnp.68.3.337
Ryttlefors M, Howells T, Nilsson P, Ronne-Engstrom E, Enblad P (2007) Secondary insults in subarachnoid hemorrhage: occurrence and impact on outcome and clinical deterioration. Neurosurgery 61:704–714 discussion 714-705
doi: 10.1227/01.NEU.0000298898.38979.E3
Samuelsson C, Howells T, Kumlien E, Enblad P, Hillered L, Ronne-Engstrom E (2009) Relationship between intracranial hemodynamics and microdialysis markers of energy metabolism and glutamate-glutamine turnover in patients with subarachnoid hemorrhage. Clinical article. J Neurosurg 111:910–915
doi: 10.3171/2008.8.JNS0889
Toulouse E, Masseguin C, Lafont B, McGurk G, Harbonn A, Roberts JA, Granier S, Dupeyron A, Bazin JE (2018) French legal approach to clinical research. Anaesth Crit Care Pain Med 37:607–614
doi: 10.1016/j.accpm.2018.10.013
van Gijn J, Hijdra A, Wijdicks EF, Vermeulen M, van Crevel H (1985) Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355–362
doi: 10.3171/jns.1985.63.3.0355
Vergouwen MD, Ilodigwe D, Macdonald RL (2011) Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke 42:924–929
doi: 10.1161/STROKEAHA.110.597914
Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, Mendelow AD, Juvela S, Yonas H, Terbrugge KG, Macdonald RL, Diringer MN, Broderick JP, Dreier JP, Roos YB (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 41:2391–2395
doi: 10.1161/STROKEAHA.110.589275
Westermaier T, Pham M, Stetter C, Willner N, Solymosi L, Ernestus RI, Vince GH, Kunze E (2014) Value of transcranial Doppler, perfusion-CT and neurological evaluation to forecast secondary ischemia after aneurysmal SAH. Neurocrit Care 20:406–412
doi: 10.1007/s12028-013-9896-0
Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE Jr, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS (2011) 2011 ACCF/AHA focused update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 57:1920–1959
doi: 10.1016/j.jacc.2011.02.009