Neurovascular Events After Subarachnoid Hemorrhage pp 183-186

Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 120) | Cite as

Real-Time Changes in Brain Tissue Oxygen During Endovascular Treatment of Cerebral Vasospasm

  • Rune Rasmussen
  • Søren Bache
  • Trine Stavngaard
  • Jane Skjøth-Rasmussen
  • Bertil Romner
Chapter

Abstract

The use of endovascular intervention to treat cerebral vasospasm after subarachnoid hemorrhage has increased. Although the effect on angiographic vasospasm can be easily demonstrated, the effect on cerebral blood flow and clinical outcome is still controversial. In this report, we investigate minute-by-minute changes in brain tissue oxygen during balloon angioplasty and intraarterial administration of vasodilators in three patients.

Our results confirm that endovascular intervention is capable of not only resolving angiographic vasospasm, but also of normalizing values of brain tissue oxygen pressure (PtiO2) in target parenchyma. However, during the intervention, dangerously low levels of brain tissue oxygen, leading to cerebral infarction, may occur. Thus, no clinical improvement was seen in two of the patients and a dramatic worsening was observed in the third patient. Because the decrease in brain tissue oxygen was seen after administration of vasopressor agents, this may be a contributing factor.

Keywords

Subarachnoid hemorrhage Cerebral vasospasm Endovascular intervention Brain tissue oxygen monitoring 

References

  1. 1.
    Al-Tamimi YZ, Orsi NM, Quinn AC, Homer-Vanniasinkam S, Ross SA (2010) A review of delayed ischemic neurologic deficit following aneurysmal subarachnoid hemorrhage: historical overview, current treatment, and pathophysiology. World Neurosurg 73:654–667PubMedCrossRefGoogle Scholar
  2. 2.
    Deshaies EM, Jacobsen W, Singla A, Li F, Gorji R (2012) Brain tissue oxygen monitoring to assess reperfusion after intra-arterial treatment of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm: a retrospective study. AJNR Am J Neuroradiol 33:1411–1415PubMedCrossRefGoogle Scholar
  3. 3.
    Dorsch NW (1995) Cerebral arterial spasm – a clinical review. Br J Neurosurg 9:403–412PubMedCrossRefGoogle Scholar
  4. 4.
    Hoelper BM, Hofmann E, Sporleder R, Soldner F, Behr R (2003) Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report. Neurosurgery 52:970–974PubMedCrossRefGoogle Scholar
  5. 5.
    Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J (2005) Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien) 147:51–56CrossRefGoogle Scholar
  6. 6.
    Keyrouz SG, Diringer MN (2007) Clinical review: prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care 11:220PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Stiefel MF, Spiotta AM, Udoetuk JD, Maloney-Wilensky E, Weigele JB, Hurst RW, LeRoux PD (2006) Intra-arterial papaverine used to treat cerebral vasospasm reduces brain oxygen. Neurocrit Care 4:113–118PubMedCrossRefGoogle Scholar
  8. 8.
    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 41:2391–2395PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Rune Rasmussen
    • 1
  • Søren Bache
    • 2
  • Trine Stavngaard
    • 3
  • Jane Skjøth-Rasmussen
    • 1
  • Bertil Romner
    • 1
  1. 1.Department of NeurosurgeryCopenhagen University HospitalCopenhagenDenmark
  2. 2.Department of NeuroanesthesiologyCopenhagen University HospitalCopenhagenDenmark
  3. 3.Department of RadiologyCopenhagen University HospitalCopenhagenDenmark

Personalised recommendations