Abstract
BackgroundCerebral arterial vasospasm leads to delayed cerebral ischemia and constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage. Cerebral vasospasm can be reduced by increased blood clearance from the subarachnoid space. Clinical pilot studies allow the hypothesis that the clearance of subarachnoid blood is facilitated by means of head shaking. A major obstacle for meaningful clinical studies is the lack of data on appropriate parameters of head shaking. Our in vitro study aims to provide these essential parameters.Methodology/Principal FindingsA model of the basal cerebral cistern was derived from human magnetic resonance imaging data. Subarachnoid hemorrhage was simulated by addition of dyed experimental blood to transparent experimental cerebrospinal fluid (CSF) filling the model of the basal cerebral cistern. Effects of various head positions and head motion settings (shaking angle amplitudes and shaking frequencies) on blood clearance were investigated using the quantitative dye washout method. Blood washout can be divided into two phases: Blood/CSF mixing and clearance. The major effect of shaking consists in better mixing of blood and CSF thereby increasing clearance rate. Without shaking, blood/CSF mixing and blood clearance in the basal cerebral cistern are hampered by differences in density and viscosity of blood and CSF. Blood clearance increases with decreased shaking frequency and with increased shaking angle amplitude. Head shaking facilitates clearance by varying the direction of gravitational force.Conclusions/SignificanceFrom this in vitro study can be inferred that patient or head shaking with large shaking angles at low frequency is a promising therapeutic strategy to increase blood clearance from the subarachnoid space.
Highlights
Despite the elaborate current treatment strategies, cerebral arterial vasospasm leading to delayed cerebral ischemia constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage (SAH)
Two different head motion strategies, translational movement [7,8] and bidirectional rotation [9], have been applied clinically. Since in these studies head motion was combined with an intensified lumboventricular lavage [9], the contribution of bidirectional rotation to the clearance of the subarachnoid space is difficult to dissect from the effect of increased cerebrospinal fluid (CSF) flow
Quantitative dye visualization was used to study in vitro the effects of head shaking on blood clearance in a model of cisternal SAH
Summary
Despite the elaborate current treatment strategies, cerebral arterial vasospasm leading to delayed cerebral ischemia constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage (SAH). Being a function of the amount of subarachnoid blood, the incidence of vasospasm can be reduced by increasing blood clearance from the basal cerebral cisterns This can be achieved by means of increased perfusion of the subarachnoid space with CSF alone [5] or combined with intracisternal thrombolysis [6]. Two different head motion strategies, translational movement [7,8] and bidirectional rotation [9], have been applied clinically Since in these studies head motion was combined with an intensified lumboventricular lavage [9], the contribution of bidirectional rotation to the clearance of the subarachnoid space is difficult to dissect from the effect of increased CSF flow. Our in vitro study aims to provide these essential parameters
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