Departments of1Neurology and.
2Neurosurgery, University of New Mexico, Albuquerque; and.
J Neurosurg. 2023 Mar 31;139(4):1036-1041. doi: 10.3171/2023.2.JNS23295. Print 2023 Oct 1.
The management of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH) remains one of the most important targets for neurocritical care. Advances in monitoring technology have facilitated a more thorough understanding of the pathophysiology and therapeutic approaches, but interventions are generally limited to either systemic therapies or passive CSF drainage. The authors present a novel approach that combines a multimodal monitoring bolt-based system with an irrigating ventricular drain capable of delivering intrathecal medications and describe their early experience in patients with aSAH.
The authors performed a retrospective review of cases treated with the combined Hummingbird multimodal bolt system and the IRRAflow irrigating ventriculostomy.
Nine patients were treated with the combined multimodal bolt system with irrigating ventriculostomy approach. The median number of days to clearance of the third and fourth ventricles was 3 days in patients with obstructive intraventricular hemorrhage. Two patients received intrathecal alteplase for intraventricular hemorrhage clearance, and 2 patients received intrathecal nicardipine as rescue therapy for severe symptomatic angiographic vasospasm.
Combined CSF drainage, irrigation, multimodality monitoring, and automated local drug delivery are feasible using a single twist-drill hole device. Further investigation of irrigation settings and treatment approaches in high-risk cases is warranted.
动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血的管理仍然是神经危重症治疗的最重要目标之一。监测技术的进步使人们更深入地了解了病理生理学和治疗方法，但干预措施通常仅限于全身治疗或被动脑脊液引流。作者提出了一种新的方法，即结合基于多模态监测螺栓的系统和能够输送鞘内药物的灌洗脑室引流管，并描述了他们在 aSAH 患者中的早期经验。
作者对接受联合蜂鸟多模态螺栓系统和 IRRAflow 灌洗脑室造口术治疗的病例进行了回顾性研究。
9 例患者接受了联合多模态螺栓系统和灌洗脑室造口术治疗。梗阻性脑室内出血患者脑室第三和第四脑室清除的中位数天数为 3 天。2 例患者接受了鞘内阿替普酶以清除脑室内出血，2 例患者接受了鞘内尼卡地平作为严重症状性血管痉挛的抢救治疗。
使用单个旋入式钻头装置可实现 CSF 引流、灌洗、多模态监测和自动局部药物输送的联合。有必要进一步研究高危病例中的灌洗设置和治疗方法。
