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Cervical Ganglion Sympathectomy to Treat Cerebral Vasospasm in Subarachnoid Hemorrhage

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Abstract

Delayed cerebral ischemia (DCI) is still a significant cause of death and disability after aneurysmal subarachnoid hemorrhage. Cerebral vasospasm represents one of the most reported mechanisms associated with DCI. The management of DCI-related vasospasm remains a significant challenge for clinicians; induced hypertension, intraarterial vasodilators, and/or intracranial vessel angioplasty—particularly in refractory or recurrent cases—are the most used therapies. Because an essential role in the pathophysiology of cerebral vasospasm has been attributed to the adrenergic sympathetic nerves, a “sympatholytic” intervention, consisting of a temporary interruption of the sympathetic pathways using local anesthetics, has been advocated to minimize the vascular narrowing and reverse the consequences of cerebral vasospasm on tissue perfusion. In this review, we have analyzed the existing literature on the block of the cervical ganglions, particularly the stellate ganglion, in managing refractory cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. These findings could help clinicians to understand the potential role of such intervention and to develop future interventional trials in this setting.

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  1. Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium

    Michele Salvagno, Elisa Gouvea Bogossian, Katarina Halenarova & Fabio Silvio Taccone

  2. Department of Intensive Care, Hôpitaux Iris Sud, Brussels, Belgium

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  1. Michele Salvagno
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MS: drew the figure, helped to design the study and wrote sections of the final article; EGB: helped to design the study and wrote sections of the final article; FST: helped to design the study and wrote sections of the final article. All the authors reviewed the article for intellectual content and approve the final manuscript.

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Salvagno, M., Gouvea Bogossian, E., Halenarova, K. et al. Cervical Ganglion Sympathectomy to Treat Cerebral Vasospasm in Subarachnoid Hemorrhage. Neurocrit Care 39, 241–249 (2023). https://doi.org/10.1007/s12028-023-01694-5

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