Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, USA
Neurology, Stanford University School of Medicine, Stanford, California, USA.
J Neurointerv Surg. 2023 Dec;15(12):1212-1217. doi: 10.1136/jnis-2022-019838. Epub 2022 Dec 6.
Delayed cerebral ischemia (DCI) affects 30% of patients following aneurysmal subarachnoid hemorrhage (aSAH) and is a major driver of morbidity, mortality, and intensive care unit length of stay for these patients. DCI is strongly associated with cerebral arterial vasospasm, reduced cerebral blood flow and cerebral infarction. The current standard treatment with intravenous or intra-arterial calcium channel antagonist and balloon angioplasty or stent has limited efficacy. A simple treatment such as a cervical sympathetic block (CSB) may be an effective therapy but is not routinely performed to treat vasospasm/DCI. CSB consists of injecting local anesthetic at the level of the cervical sympathetic trunk, which temporarily blocks the innervation of the cerebral arteries to cause arterial vasodilatation. CSB is a local, minimally invasive, low cost and safe technique that can be performed at the bedside and may offer significant advantages as complementary treatment in combination with more conventional neurointerventional surgery interventions. We reviewed the literature that describes CSB for vasospasm/DCI prevention or treatment in humans after aSAH. The studies outlined in this review show promising results for a CSB as a treatment for vasospasm/DCI. Further research is required to standardize the technique, to explore how to integrate a CSB with conventional neurointerventional surgery treatments of vasospasm and DCI, and to study its long-term effect on neurological outcomes.
迟发性脑缺血（DCI）影响 30%的蛛网膜下腔出血（aSAH）患者，是这些患者发病率、死亡率和重症监护病房住院时间的主要驱动因素。DCI 与脑动脉血管痉挛、脑血流减少和脑梗死密切相关。目前，静脉或动脉内钙通道拮抗剂和球囊血管成形术或支架治疗的标准治疗效果有限。一种简单的治疗方法，如颈部交感神经阻滞（CSB），可能是一种有效的治疗方法，但常规不用于治疗血管痉挛/DCI。CSB 包括在颈部交感神经干水平注射局部麻醉剂，暂时阻断大脑动脉的神经支配，导致动脉扩张。CSB 是一种局部、微创、低成本和安全的技术，可以在床边进行，并且可能作为更传统的神经介入手术干预的辅助治疗提供显著优势。我们回顾了描述 CSB 在 aSAH 后预防或治疗血管痉挛/DCI 的人类文献。本综述中概述的研究表明 CSB 作为血管痉挛/DCI 治疗的一种有前途的方法。需要进一步的研究来规范该技术，探索如何将 CSB 与血管痉挛和 DCI 的常规神经介入手术治疗相结合，并研究其对神经功能结局的长期影响。
