ABSTRACT
INTRODUCTION: Cisternal and ventricular blood predisposes to hydrocephalus and cerebral ischemia after high-grade aneurysmal subarachnoid hemorrhage (HGSAH). We studied the role of lamina terminalis fenestration combined with cisternal blood evacuation in HGSAH. PATIENTS/MATERIALS AND METHODS: A clinical, prospective, non-randomized study of a series of HGSAH patients (Modified Fisher>or=3) treated in the acute phase was carried out. The microsurgical treatment included aneurysm clipping, cisternal blood evacuation, and fenestration of the lamina terminalis. A comparable, non-blood-cleansed, endovascular-treated group, was included as a control. Clinical results were evaluated by the Glasgow Outcome Scale (GOS). RESULTS: During a period of 30 months, 95 patients who met the selection criteria were treated by microsurgical procedures and 28 by endovascular procedures. The distribution of GOS scores was superior for the microsurgical group: good results (GOS 4-5) were obtained in 85.3%, with a mortality rate of 5.9%. By contrast, 60.3% of patients in the endovascular group achieved GOS 4-5 scores, and 15.8% died. Good results for the endovascular group correlated inversely with delay of treatment. A permanent ventriculo-peritoneal shunt was necessary in 3.2% and 7.1% of the microsurgical and endovascular groups, respectively. The incidence of cerebral infarct was 3.1% and 14.3% for the microsurgical and endovascular groups, respectively. DISCUSSION: Microsurgical management reduces the usually poor outcome of patients with HGSAH. Lamina terminalis fenestration diminishes the incidence of shunt-dependent hydrocephalus and, combined with extensive cisternal blood cleansing, can lower the incidence of stroke. A procedure for cleansing blood and clots from the cisterns in HGSAH, based on the pathophysiology of vasospasm, is proposed.
Subject(s)
Hypothalamus/surgery , Intracranial Thrombosis/surgery , Microsurgery/methods , Subarachnoid Hemorrhage/surgery , Subarachnoid Space/surgery , Ventriculostomy/methods , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/pathology , Cerebral Arteries/physiopathology , Female , Humans , Hydrocephalus/etiology , Hypothalamus/anatomy & histology , Hypothalamus/physiology , Intracranial Thrombosis/etiology , Intracranial Thrombosis/physiopathology , Male , Prospective Studies , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/physiopathology , Subarachnoid Space/diagnostic imaging , Subarachnoid Space/physiopathology , Third Ventricle/anatomy & histology , Third Ventricle/physiology , Third Ventricle/surgery , Tomography, X-Ray Computed , Treatment Outcome , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/prevention & control , Vasospasm, Intracranial/surgeryABSTRACT
This study investigates the role of cervical sympathectomy in the prevention of acute vasospasm induced by meningeal haemorrhage in rabbits. Sixteen adult English Norfolk rabbits were divided into 2 experimental groups: bilateral cervical sympathectomy of the superior sympathetic ganglion (SSSG, n=8), and bilateral SSSG and sympathectomy of the inferior sympathetic ganglion (SISG, n=8). Other 24 animals were used as controls. Basilar artery diameter was evaluated by angiography. SSSG protected the animals against developing cerebral vasospasm; SSSG associated with SISG did not increase this effect.
Subject(s)
Cerebral Hemorrhage/surgery , Ganglionectomy/methods , Vasospasm, Intracranial/surgery , Acute Disease , Animals , Cerebral Hemorrhage/complications , Disease Models, Animal , Ganglia, Sympathetic/surgery , Rabbits , Vasospasm, Intracranial/etiologyABSTRACT
This study investigates the role of cervical sympathectomy in the prevention of acute vasospasm induced by meningeal haemorrhage in rabbits. Sixteen adult English Norfolk rabbits were divided into 2 experimental groups: bilateral cervical sympathectomy of the superior sympathetic ganglion (SSSG, n=8), and bilateral SSSG and sympathectomy of the inferior sympathetic ganglion (SISG, n=8). Other 24 animals were used as controls. Basilar artery diameter was evaluated by angiography. SSSG protected the animals against developing cerebral vasospasm; SSSG associated with SISG did not increase this effect.
Este estudo investiga o papel da simpatectomia cervical na prevenção do vasoespasmo agudo induzido por hemorragia meníngea em coelhos. Para tanto, foram utilizados 16 coelhos adultos da raça Norfolk inglesa, divididos em 2 grupos experimentais: simpatectomia cervical bilateral do gânglio simpático cervical superior (SSSG, n=8) e SSSG associada a simpatectomia cervical bilateral do gânglio simpático cervical inferior (SISG, n=8). Outros 24 animais foram usados como controles. Os diâmetros das artérias basilares foram avaliados por medições após angiografias. SSSG protegeu os animais contra o vasoespasmo; SSSG associada a SISG não aumentou este efeito.