title: Results of a national cerebrovascular neurosurgery survey on the management of cerebral vasospasm/delayed cerebral ischemia.
abstract: OBJECTIVE
  Following aneurysmal subarachnoid hemorrhage, cerebral vasospasm/delayed cerebral ischemia accounts for significant morbidity and mortality. In this paper we provide the first glimpse of actual practice in the management of cerebral vasospasm in the USA.
  
  
  METHODS
  All active members of the Joint American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Cerebrovascular Section were emailed the survey. The responses were collected anonymously.
  
  
  RESULTS
  The response rate for this survey was 44% (177 responses/400 total members). Non-responders were characterized by the fact that multiple responders were not obtained from practices that had multiple providers with uniform practice. Both high-volume and low-volume centers were equally represented. Optimizing medical management is first-line treatment in practice. Although there is some variability regarding screening methods, the greatest variability occurs with regard to the choice of intra-arterial treatment drug and dose. There is also considerable variability in the perceived effectiveness of endovascular treatment for vasospasm.
  
  
  CONCLUSIONS
  In this preliminary glimpse of actual cerebral vasospasm management practice in the USA, two salient points emerge: (1) there is considerable variability in intra-arterial therapies for vasospasm; and (2) there are major differences in the perceived effectiveness of these therapies. Standardization of intra-arterial therapies may contribute to improved outcomes. A prospective randomized trial evaluating endovascular treatment for cerebral vasospasm is needed.
authors.affiliation: Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
authors.affiliation: Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Murat
authors.initials: M
authors.lastname: Günel
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
authors.affiliation: University of Texas, Medical School at Houston, Houston, Texas, USA.
authors.forename: Peng Roc
authors.initials: PR
authors.lastname: Chen
authors.affiliation: Columbia University, Neurological Institute of New York, New York, New York, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Friedlander
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D012955:Societies, Medical; D014463:Ultrasonography; D014481:United States; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Aneurysm; Angioplasty; Intervention