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World Neurosurg. 2019 Mar 18. pii: S1878-8750(19)30751-X. doi: 10.1016/j.wneu.2019.03.083. [Epub ahead of print]

A review on the management of cerebral vasospasm following aneurysmal subarachnoid haemorrhage.

Author information

1
School of Medicine - Faculty of Health, Deakin University, 75 Pigdons Road, Geelong, Victoria 3216, Australia. Electronic address: kenny.li@live.com.au.
2
University of Adelaide, Level 3, Helen Mayo North, Frome Road, North Terrace Campus, Adelaide, South Australia 5005, Australia; The South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia. Electronic address: christenbarras@gmail.com.
3
Interventional Neuroradiology Service, Monash Health, 249 Clayton Road, Clayton, Victoria, 3168, Australia. Electronic address: ronilc@gmail.com.
4
Interventional Radiology Service, Northern Health, 185 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: terrykok@gmail.com.
5
School of Medicine - Faculty of Health, Deakin University, 75 Pigdons Road, Geelong, Victoria 3216, Australia; Interventional Radiology Service - Department of Radiology, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia; Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: julian.maingard@gmail.com.
6
Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5, 35 Rainforest Walk, Clayton, Victoria 3800, Australia. Electronic address: nscar6@student.monash.edu.
7
Department of Neurosurgery, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: Jeremy.russell77@gmail.com.
8
Department of Neurosurgery, Monash Health, 249 Clayton Road, Clayton, Victoria, 3168, Australia. Electronic address: Leon.Lai@monashhealth.org.
9
Interventional Radiology Service - Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; The Florey Institute of Neuroscience and Mental health, 30 Royal Parade, Parkville, Victoria 3052, Australia. Electronic address: Mark.Brooks@austin.org.au.
10
School of Medicine - Faculty of Health, Deakin University, 75 Pigdons Road, Geelong, Victoria 3216, Australia; Interventional Radiology Service - Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; The Florey Institute of Neuroscience and Mental health, 30 Royal Parade, Parkville, Victoria, 3052, Australia. Electronic address: asadi.hamed@gmail.com.

Abstract

BACKGROUND:

Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysm subarachnoid haemorrhage (aSAH).

OBJECTIVE:

To define the scope of the problem and review key treatment strategies that have shaped the way cerebral vasospasm is managed in the contemporary era.

METHODS:

A literature search of cerebral vasospasm management after aneurysmal subarachnoid haemorrhage was performed.

RESULTS:

Recent advances in neuroimaging have led to an improved detection of vasospasm, but established treatment guidelines including haemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centres. Experimental research in SAH continues to identify novel targets for therapy.

CONCLUSIONS:

Proactive and preventative strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.

KEYWORDS:

Aneurysmal subarachnoid haemorrhage; delayed cerebral ischaemia; delayed ischaemic neurologic deficits; endovascular; intra-arterial vasodilator; transluminal balloon angioplasty; vasospasm

PMID:
30898740
DOI:
10.1016/j.wneu.2019.03.083

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