Innovative approach for prevention and treatment of post subarachnoid hemorrhage vasospasm: A preliminary report

Abstract

More than one third of patients with subarachnoid hemorrhage (SAH) develop clinically significant vasospasm, as a leading morbidity and mortality factor for these patients. It is widely accepted that a) Degradation products of blood are the causative factors of vasospasm b) The amount of subarachnoid blood seen on admission CT is correlated to the risk of vasospasm c) Reducing the subarachnoid clot burden at the time of surgery reduces the risk of vasospasm. But there is no existing method to clear the blood from subarachnoid spaces satisfactorily. We have evaluated safety and feasibility of fluid exchange catheter system in SAH, to achieve this goal. We were successful in clearing cisternal blood in three patients with aneurysmal rupture with fluid exchange catheter system. Baseline CT scan of brain was performed immediately after the surgery and then at the end of irrigation. The amount of subarachnoid blood was evaluated. This innovative, fluid exchange catheter system infuses and aspirates micro volumes of drug solution in a cyclic mode, ensuring isobaric exchange of fluids. The result is good clearance of blood in subarachnoid spaces were seen in all the patients. Also, significant improvement in neurological deficits secondary to vasospasm was seen. We conclude that the fluid exchange catheter system is safe and adoptable in neurosurgical practice.

Keywords: Cisternal blood; flux irrigation system; subarachnoid hemorrhage; vasospasm.

Figure 1

(a) Preoperative CT brain scan showing SAH in Rt. sylvian fissure and Rt. ambient cistern (b) CT brain scan showing clearance of subarachnoid blood (post-FLUX use)

Figure 2

(a) CT brain scan showing hematoma and subarachnoid blood in right ambient cistern, immediately after clipping (b) Seventy two hours post-irrigation CT brain scan showing clearance of subarachnoid blood, FLUX catheter in situ