• Nakao Ota, Hidetoshi Matsukawa, Hiroyasu Kamiyama, Toshiyuki Tsuboi, Kosumo Noda, Atsumu Hashimoto, Takanori Miyazaki, Yu Kinoshita, Norihiro Saito, Sadahisa Tokuda, Kyousuke Kamada, and Rokuya Tanikawa.
• Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
• World Neurosurg. 2017 Nov 1; 107: 630-640.

BackgroundA subarachnoid clot is the strongest predictor of cerebral vasospasm. Our purpose was to analyze the relationship between the number of postoperative cisternal clots and cerebral vasospasm and to assess the efficacy of surgical clot removal.MethodsThe subjects were 158 patients with aneurysmal subarachnoid hemorrhage. All patients underwent clipping with cisternal clot removal. The preoperative and postoperative number of clots was analyzed semiquantitatively using computed tomography, and cerebral vasospasm and its severity were analyzed using magnetic resonance angiography in a blind fashion. Factors related to cerebral vasospasm and poor outcome were analyzed retrospectively. Poor outcome was defined as modified Rankin Scale (mRS) score of 3 or greater.ResultsSymptomatic cerebral vasospasm (SCV) was observed in 6 patients (3.8%). Angiographic vasospasm (AVS) was observed in 38 patients (24.1%). One year after the operation, 82.9% of patients had an mRS score of 0-2. The postoperative number of clots was significantly (P < 0.005) related to SCV (adjusted odds ratio [OR], 6.447; 95% confidence interval [CI], 2.063-20.146), AVS (OR, 2.634; 95% CI, 1.467-4.728), and poor outcome (OR, 2.103; 95% CI, 1.104-4.007). Poor outcome was also related to age over 65 (OR, 6.658; 95% CI, 2.389-18.559) and World Federation of Neurosurgical Societies scale grade (OR, 1.732; 95% CI, 1.248-2.403).ConclusionsSurgically removing as many clots as possible in the acute stage can decrease SCV and reduce AVS severity. Irrigation should be performed on all approachable cisterns.Copyright © 2017 Elsevier Inc. All rights reserved.

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