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Role of Bedside Multimodality Monitoring in the Detection of Cerebral Vasospasm Following Subarachnoid Hemorrhage

  • Kasra KhatibiEmail author
  • Viktor Szeder
  • Manuel Buitrago Blanco
  • Satoshi Tateshima
  • Reza Jahan
  • Gary Duckwiler
  • Paul Vespa
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 127)

Abstract

Background. Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO2) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI.

Methods. All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO2 and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO2, lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm.

Results. A total of ten patients with aSAH who underwent MMM were identified. PbtO2 decline correlates with severity of proximal vasospasm (r = −0.66). PbtO2 was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different.

Conclusion. Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO2 and CMD help in real-time detection and management of DCI.

Keywords

Delayed cerebral ischemia Cerebral vasospasm Multimodality monitoring Brain tissue oxygen tension Cerebral microdialysis 

Notes

Conflict of Interest

We declare that we have no conflict of interest.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Kasra Khatibi
    • 1
    Email author
  • Viktor Szeder
    • 2
  • Manuel Buitrago Blanco
    • 1
  • Satoshi Tateshima
    • 2
  • Reza Jahan
    • 2
  • Gary Duckwiler
    • 2
  • Paul Vespa
    • 1
  1. 1.Division of Neurocritical Care, Department of NeurosurgeryUniversity of California Los AngelesLos AngelesUSA
  2. 2.Department of RadiologyUniversity of California Los AngelesLos AngelesUSA

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