Der Einfluss des temporären Clippings auf die Häufigkeit zerebraler Vasospasmen nach aneurysmatischer Subarachnoidalblutung

Der Einfluss des temporären Clippings auf die Häufigkeit zerebraler Vasospasmen nach aneurysmatischer Subarachnoidalblutung

The Influence of Temporary Clipping on the Incidence of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

Martin Voit

Doctoral thesis

Date of Examination: 2017-06-28

Date of issue: 2017-06-13

Advisor: Mielke, Dorothee Prof. Dr.

Referee: Mielke, Dorothee Prof. Dr.

Referee: Knauth, Michael Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0023-3E75-9

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Abstract

English

The treatment of aneurysmal subarachnoid hemorrhage (aSAH) still is a major concerne in the field of neurological diseases. Despite improved diagnostics and therapies, the mortality and morbidity after aSAH remains at a high level. While there is an ongoing discussion on advantages and disadvantages of clipping or coiling as the main treatment of ruptured aneurysms, a focus also lies on preventing and managing the following complications occurring in many patients. One of the main challenges is handling arterial vasospasms after aSAH, which is a major contributor to poor outcome. The aim of this thesis was to examine the influence of temporary clipping in the course of aneurysm clipping surgery on arterial vasospasm. A cohort of 535 patients undergoing surgical aneurysm treatment after aSAH was analyzed. Data on clinical condition (Glasgow Coma Scale), Hunt & Hess score, Fisher grade, incidence of temporary clipping, vasospasm (on the basis of transcranial Doppler sonography), neurological deficits and ischemic lesions were collected as well as medical complications and outcome (Glasgow Outcome Scale). Analysis showed no significant influence of temporary clipping on postoperative development in general and vasospasm in particular. Other factors like severity of aSAH or age therefore have significant impact, as known also from other studies. Temporary clipping during surgery of ruptured aneurysms showed to be a safe treatment option without negative influence on complications or outcome of the patient.

Keywords: Temporary Clipping; Aneurysmal Subarachoid Hemorrhage; Cerebral Vasospasm