A Review of the Management of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysmal subarachnoid hemorrhage.

Objective: To define the scope of the problem and review key treatment strategies that have shaped the way CV is managed in the contemporary era.

Methods: A literature search was performed of CV management after aneurysmal subarachnoid hemorrhage.

Results: Recent advances in neuroimaging have led to improved detection of vasospasm, but established treatment guidelines including hemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centers. Experimental research in subarachnoid hemorrhage continues to identify novel targets for therapy.

Conclusions: Proactive and preventive strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.

Keywords: Aneurysmal subarachnoid hemorrhage; Delayed cerebral ischemia; Delayed ischemic neurologic deficits; Endovascular; Intra-arterial vasodilator; Transluminal balloon angioplasty; Vasospasm.