title: Massive Cerebrospinal Fluid Replacement Reduces Delayed Cerebral Vasospasm After Embolization of Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND Delayed cerebral vasospasm (DCVS) following aneurismal subarachnoid hemorrhage (SAH) is a leading cause of poor prognosis and death in SAH patients. Effective management to reduce DCVS is needed. A prospective controlled trial was conducted to determine if massive cerebrospinal fluid (CSF) replacement (CR) could reduce DCVS occurrence and improve the clinical outcome after aneurysmal SAH treated with endovascular coiling. MATERIAL AND METHODS Patients treated with endovascular coiling after aneurysmal SAH were randomly divided into a control group receiving regular therapy alone (C group, n=42) and a CSF replacement group receiving an additional massive CSF replacement with saline (CR group, n=45). CSF examination, head CT, DCVS occurrence, cerebral infarction incidence, Glasgow Outcome Scale prognostic score, and 1-month mortality were recorded. RESULTS The occurrence of DCVS was 30.9% in the C group and 4.4% in the CR group (P<0.005). The cerebral infarction incidences in the C and CR groups were 19.0% and 2.2% (P<0.05), respectively, 1 month after the treatments. Mortality was not significantly different between the 2 groups during the follow-up period. CONCLUSIONS Massive CR after embolization surgery for aneurysmal SAH can significantly reduce DCVS occurrence and effectively improve the outcomes.
authors.affiliation: Center of Cerebrovascular Disease, No. 404 Hospital of PLA, Weihai, Shandong, China (mainland).
authors.forename: Liming
authors.initials: L
authors.lastname: Geng
authors.affiliation: Center of Cerebrovascular Disease, No. 404 Hospital of PLA, Weihai, Shandong, China (mainland).
authors.forename: Fei
authors.initials: F
authors.lastname: Ma
authors.affiliation: Center of Cerebrovascular Disease, No. 404 Hospital of PLA, Weihai, Shandong, China (mainland).
authors.forename: Yun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Center of Cerebrovascular Disease, No. 404 Hospital of PLA, Weihai, Shandong, China (mainland).
authors.forename: Yanchun
authors.initials: Y
authors.lastname: Mu
authors.affiliation: Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Zou
mesh_terms: D000328:Adult; D002544:Cerebral Infarction / Q000134:cerebrospinal fluid / Q000209:etiology / Q000517:prevention & control; D002555:Cerebrospinal Fluid; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000134:cerebrospinal fluid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000134:cerebrospinal fluid / Q000209:etiology / Q000517:prevention & control*