Transcranial cerebral oximetry and transcranial doppler sonography in patients with ruptured cerebral aneurysms and delayed cerebral vasospasm.

BACKGROUND: Vasospasm is a major cause of ischemic neurological deficits developing after subarachnoid hemorrhage. The goal was to identify hemodynamic changes and the presence of clinical vasospasm in patients suffering from subarachnoid hemorrhage secondary to ruptured intracranial aneurysms. MATERIAL/METHODS: Pre- and postoperative serial transcranial cerebral oximetry and transcranial doppler sonography (TCD) examinations were performed in 75 patients operated for aneurysmal subarachnoid hemorrhage. RESULTS: No significant difference (p=0.14) was found in the levels of regional oxygen saturation (rSO2) between patients with vasospasm and those without. In patients who developed clinical vasospasm, the blood flow velocity values were significantly higher compared with those who did not (127.5+/-2.7 versus 92.5+/-1.2 cm/sec, p<0.001). In six patients with clinical vasospasm and low TCCO measurements, the use of triple-H therapy led to oxygen saturation increment and clinical improvement. CONCLUSIONS: Transcranial cerebral oximetry seems to be of limited value for the detection of vasospasm in patients with subarachnoid hemorrhage. However, it may be useful in estimating the clinical impact of triple-H therapy in such patients.