Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon (Lyon University Hospital), Lyon, France.
Creatis Lab, CNRS UMR 5220, INSERM U1206, Lyon 1 University, INSA Lyon, Lyon, France.
Adv Tech Stand Neurosurg. 2022;45:229-244. doi: 10.1007/978-3-030-99166-1_7.
Despite significant advances in the management of aneurysmal subarachnoid hemorrhage (SAH), morbidity and mortality remain devastating particularly for high-grade SAH. Poor functional outcome usually results from delayed cerebral ischemia (DCI). The pathogenesis of DCI during aneurysmal SAH has historically been attributed to cerebral vasospasm, but spreading depolarizations (SDs) are now considered to play a central role in DCI. During SAH, SDs may produce an inverse hemodynamic response leading to spreading ischemia. Several animal models have contributed to a better understanding of the pathogenesis of SDs during aneurysmal SAH and provided new therapeutic approaches including N-methyl-D-aspartate receptor antagonists and phosphodiesterase inhibitors. Herein we review the current knowledge in the field of SDs' pathogenesis and we detail the key experimental and clinical studies that have opened interesting new therapeutic approaches to prevent DCI in aneurysmal SAH.
尽管在处理颅内动脉瘤性蛛网膜下腔出血 (SAH) 方面取得了重大进展，但发病率和死亡率仍然很高，尤其是对于高分级的 SAH。功能预后不良通常是由迟发性脑缺血 (DCI) 引起的。在颅内动脉瘤性 SAH 中，DCI 的发病机制传统上归因于脑血管痉挛，但现在认为扩散性去极化 (SDs) 在 DCI 中起核心作用。在 SAH 期间，SD 可能会产生反向血液动力学反应，导致扩散性缺血。几个动物模型有助于更好地理解颅内动脉瘤性 SAH 期间 SD 的发病机制，并提供了新的治疗方法，包括 N-甲基-D-天冬氨酸受体拮抗剂和磷酸二酯酶抑制剂。本文综述了 SD 发病机制领域的最新知识，并详细介绍了关键的实验和临床研究，这些研究为预防颅内动脉瘤性 SAH 中的 DCI 开辟了有趣的新治疗方法。
