Management of perimesencephalic nonaneurysmal subarachnoid hemorrhage: a national survey

• Published in: Scientific reports Vol. 13; no. 1; p. 12805
• Main Authors: Wolfert, Christina, Maurer, Christoph J., Sommer, Björn, Steininger, Kathrin, Motov, Stefan, Bonk, Maximilian-Niklas, Krauss, Philipp, Berlis, Ansgar, Shiban, Ehab
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07.08.2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/375; 692/699/375/1370; Aneurysm; Angiography; Angiography, Digital Subtraction; Blood pressure; Cerebral Angiography; Disease management; Disease prevention; Doppler effect; Hemorrhage; Humanities and Social Sciences; Humans; multidisciplinary; Neurosurgery; Prophylaxis; Questionnaires; Science; Science (multidisciplinary); Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - therapy; Subarachnoid Space; Surveys; Tomography, X-Ray Computed - adverse effects; Ultrasound; Vasoconstriction; Vasospasm, Intracranial - complications; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - therapy; Germany
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-39195-2

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (NASAH) is a rare type of subarachnoid hemorrhage (SAH), usually associated with minor complications compared to aneurysmal SAH. Up to date, data is scarce and consensus on therapeutic management and follow-up diagnostics of NASAH is often missing. This survey aims to evaluate the clinical management among neurosurgical departments in Germany. 135 neurosurgical departments in Germany received a hardcopy questionnaire. Encompassing three case vignettes with minor, moderate and severe NASAH on CT-scans and questions including the in-hospital treatment with initial observation, blood pressure (BP) management, cerebral vasospasm (CV) prophylaxis and the need for digital subtraction angiography (DSA). 80 departments (59.2%) answered the questionnaire. Whereof, centers with a higher caseload state an elevated complication rate (Chi 2  < 0.001). Initial observation on the intensive care unit is performed in 51.3%; 47.5%, 70.0% in minor, moderate and severe NASAH, respectively. Invasive BP monitoring is performed more often in severe NASAH (52.5%, 55.0%, 71.3% minor, moderate, severe). CV prophylaxis and transcranial doppler ultrasound (TCD) are performed in 41.3%, 45.0%, 63.8% in minor, moderate and severe NASAH, respectively. Indication for a second DSA is set in the majority of centers, whereas after two negative ones, a third DSA is less often indicated (2nd: 66.2%, 72.5%, 86.2%; 3rd: 3.8%, 3.8%, 13.8% minor, moderate, severe). This study confirms the influence of bleeding severity on treatment and follow-up of NASAH patients. Additionally, the existing inconsistency of treatment pathways throughout Germany is highlighted. Therefore, we suggest to conceive new treatment guidelines including this finding.