More than one third of patients with subarachnoid hemorrhage (SAH) develop clinically
significant vasospasm, as a leading morbidity and mortality factor for these patients.
It is widely accepted that a) Degradation products of blood are the causative factors
of vasospasm b) The amount of subarachnoid blood seen on admission CT is correlated
to the risk of vasospasm c) Reducing the subarachnoid clot burden at the time of surgery
reduces the risk of vasospasm. But there is no existing method to clear the blood
from subarachnoid spaces satisfactorily. We have evaluated safety and feasibility
of fluid exchange catheter system in SAH, to achieve this goal. We were successful
in clearing cisternal blood in three patients with aneurysmal rupture with fluid exchange
catheter system. Baseline CT scan of brain was performed immediately after the surgery
and then at the end of irrigation. The amount of subarachnoid blood was evaluated.
This innovative, fluid exchange catheter system infuses and aspirates micro volumes
of drug solution in a cyclic mode, ensuring isobaric exchange of fluids. The result
is good clearance of blood in subarachnoid spaces were seen in all the patients. Also,
significant improvement in neurological deficits secondary to vasospasm was seen.
We conclude that the fluid exchange catheter system is safe and adoptable in neurosurgical
practice.
Key-words:
Cisternal blood - flux irrigation system - subarachnoid hemorrhage - vasospasm
