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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Neurosurg+Anesthesiol
2015 ; 27
(3
): 222-40
Nephropedia Template TP
J Neurosurg Anesthesiol
2015[Jul]; 27
(3
): 222-40
PMID25272066
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Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high
fatality and permanent disability rates. The overall prognosis depends on the
volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia
(DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the
severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a
favorable neurological outcome with the endovascular coiling procedure compared
with surgical clipping at the end of 1 year. The ISAT trial recruits were
primarily neurologically good grade patients with smaller anterior circulation
aneurysms, and therefore the results cannot be reliably extrapolated to larger
aneurysms, posterior circulation aneurysms, patients presenting with complex
aneurysm morphology, and poor neurological grades. The role of hypothermia is not
proven to be neuroprotective according to a large randomized controlled trial,
Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which
recruited patients with good neurological grades. Patients in this trial were
subjected to slow cooling and inadequate cooling time and were rewarmed rapidly.
This methodology would have reduced the beneficial effects of hypothermia.
Adenosine is found to be beneficial for transient induced hypotension in 2
retrospective analyses, without increasing the risk for cardiac and neurological
morbidity. The neurological benefit of pharmacological neuroprotection and
neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI
is an important cause of morbidity and mortality following SAH, and the
pathophysiology is likely multifactorial and not yet understood. At present, oral
nimodipine has an established role in the management of DCI, along with
maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia,
although less common than hyponatremia, is a predictor of poor neurological
outcome.
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