Contemporary management of subarachnoid hemorrhage and vasospasm: The UIC experience

BACKGROUND Cerebral vasospasm is a well-known and serious complication of a neurysmal subarachnoid hemorrhage, The means of monitoring and treatment of vasospasm have been widely studied. Each neurosurgical center develops a p rotocol based on their experience, availability of equipment and personnel, and cost, so as to keep morbidity and mortality rates as low as possible f or their patients with vasospasm. METHODS At the University of Illinois at Chicago, we have developed algorit hms for the diagnosis and management of cerebral vasospasm based on the exp erience of the senior authors over the past 25 years. This paper describes in detail our approach to diagnosis and treatment of aneurysmal subarachnoi d hemorrhage and vasospasm. Our discussion is highlighted with data from a retrospective analysis of 324 aneurysm patients. RESULTS Over 3 years, 324 aneurysms were treated; 185 (57%) were clipped, 1 39 (43%) were coiled. The rate of vasospasm for the 324 patients was 27%. T he rate of hydrocephalus was 32% for those patients who underwent clipping, and 29% for those coiled. The immediate outcomes for those who underwent c lipping was excellent in 35%, good in 38%, poor in 15.5%, vegetative in 3%, and death in 8% of the patients. For those who underwent coiling the Immed iate outcome was excellent in 64%, good in 14.5%, vegetative in 2.5%, and d eath in 14.5% of the patients. These statistics include all Hunt and Hess g rades. For those patients who underwent clipping, 51% were Intact at 6 months foll ow-up, 15% had a permanent deficit, 10% had a focal cranial nerve deficit, and 2% had died from complications not directly related to the procedure. F or those patients who had undergone coiling, 75% were intact at 6 months fo llow-up, 12.5% had a permanent deficit, and 12.5% had a cranial nerve defic it, with no deaths. CONCLUSIONS The morbidity and mortality of cerebral vasospasm is significan t. A good outcome after aneurysmal subarachnoid hemorrhage is dependent upo n careful patient management in the preoperative, perioperative, and postop erative periods. The timely work-up and aggressive treatment of neurologica l deterioration, whether or not it is because of vasospasm, is paramount. ( C) 2001 by Elsevier Science Inc.