Management of global cerebral swelling following cerebral aneurysm surgery

Abstract

Objective To explore the management of global cerebral swelling and hyperperfusion in patients following cerebral aneurysm surgery. Methods A retrospective study was conducted on 30 patients who developed global cerebral edema post operation of intracranial aneurysm and admitted to Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from October 2011 to October 2017. The patients’ medical records, laboratory data and outcome follow-up results were analyzed. Results The GCS (Glasgow coma scale) scores were significantly increased from 9.0±1.2 to 13.7±1.5 after the treatment of withdrawal of anti-vasospasm drugs combined with dehydration therapy (P<0.01). During global cerebral edema, the global cerebral blood flow (CBF) increased 4.72(7.28) ml·100 g-1·min-1, the global cerebral blood volume (CBV) increased 0.36(0.74) ml/100 g, the mean transit time (MTT) increased 2.52(2.34) s, the maximum velocity of MCA (Vmax) increased 50.35(66.99)cm/s, the mean velocity of MCA (Vmean) increased 26.43(46.19)cm/s compared with pre-surgical data (all P<0.01). For outcome assessment, GOS grade V was reported in 22 cases, IV in 4 and III in 4 at discharge. Conclusions Cerebrovascular hyperperfusion leads to global cerebral swelling following intracranial aneurysm surgery, which needs to be differentiated from cerebral vasospasm. Withdrawal of anti-vasospasm drugs combined with dehydration therapy could alleviate global cerebral edema and improve the patient’s neurological deficits. Key words: Intracranial aneurysm; Neurosurgical procedures; Brain edema; Hemodynamics; Treatment outcome