gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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The correlation of acute clot volume and cerebral perfusion with delayed cerebral injury and poor outcome in patients with aneurysmal subarachnoid hemorrhage

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  • H.J. Heiroth - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • N. Etminan - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • K. Beseoglu - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • B. Turowski - Institut für Radiologie, Heinrich-Heine-Universität, Düsseldorf
  • H.J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • D. Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.05

doi: 10.3205/12dgnc239, urn:nbn:de:0183-12dgnc2392

Published: June 4, 2012

© 2012 Heiroth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Primary cerebral injury remains one of the most significant determinants for poor clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage (SAH). However, to date there is no immediate and quantitative radiological surrogate, which might project the subsequent extent of delayed cerebral injury following acute SAH. Therefore, we investigated the relation of acute clot volume and cerebral perfusion with events of delayed cerebral injury and clinical outcome in patients with aneurysmal subarachnoid hemorrhage (SAH).

Methods: Sixty-four patients, who received pre-treatment perfusion computerized tomography (PCT) scanning lesser than 12 hours after symptom onset, were included in this study. Clot volume was calculated using 3-dimensional volume rendering (OsiriX® Version 3.7.1). The correlation of the following SAH-related variables was investigated: 1) Initial clot volume, 2) early and median/MAXIMUN time to peak of the residue function (Tmax) 3) angiographic vasospasm 4) new cerebral infarction at discharge, 5) Glasgow Outcome Score (GOS) at discharge. Patients were dichotomized to 4 risk groups depending on clot volume (less or greater than 50 ml) and Tmax (less or greater than 3s).

Results: Initial subarachnoidal clot volume (CV) among the 64 patients measured 50,5 ± 46 ml (Mean ± SD) and correlated significantly with early Tmax measurements (R2 = 0.367, p = 0.003). Additionally, CV correlated significantly with median and peak Tmax measurements during the clinical course (days 2-11 after SAH onset) (R2 = 0.469, p < 0.001 and R2 = 0.430, p < 0.001, respectively) as well as occurrence of new cerebral infarction at discharge (R2 = 0.529, p < 0.001). There was a strong and inverse correlation of initial CV and functional outcome at discharge (R2 = –0.727; p < 0.001). Lastly, there was a significant (p < 0.001) difference between the 4 risk groups regarding the incidence of poor outcome.

Conclusions: The extent of subarachnoid clot volume and Tmax measurements in the acute phase of subarachnoid hemorrhage correlated significantly with the occurrence of delayed cerebral injury. Acute volumetric clot and perfusion measurement might serve as a predictive measure to project the extent of delayed cerebral injury and consecutively poor functional outcome in patients with aneurysmal SAH.