Bi Tianshu, Koch Henner, Kremer Benedikt, Höllig Anke
Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Germany; and.
Department of Epileptology, Neurology, Medical Faculty, RWTH Aachen University, Germany.
Neurology. 2025 Jul 8;105(1):e213767. doi: 10.1212/WNL.0000000000213767. Epub 2025 Jun 9.
Early brain injury and delayed cerebral ischemia are combined intricate processes, and they represent the principal cause of subarachnoid hemorrhage (SAH)-related morbidity and mortality worldwide. Recent studies have shown that early lumbar CSF drainage can be used to decrease the incidence of delayed cerebral ischemia and improve long-term outcome. This approach has provided novel insights into post-SAH management that lessened the burden of secondary infarction and decreased the rate of unfavorable outcome. Given that the evaluation of this approach is contingent on prospective trial and early-stage randomized clinical trial, we review insights from studies that have elucidated the mechanisms underlying deterioration in SAH. We explore the role of iron homeostasis in the restoration of normal CSF circulation and the stabilization of optimal cerebral physiology to alleviate early brain injury and delayed neurologic impairment after SAH to advance the current understanding of SAH management.
早期脑损伤和迟发性脑缺血是复杂的综合过程，是全球范围内蛛网膜下腔出血（SAH）相关发病率和死亡率的主要原因。最近的研究表明，早期腰椎脑脊液引流可用于降低迟发性脑缺血的发生率并改善长期预后。这种方法为SAH后的管理提供了新的见解，减轻了继发性梗死的负担并降低了不良预后的发生率。鉴于对该方法的评估取决于前瞻性试验和早期随机临床试验，我们回顾了阐明SAH病情恶化潜在机制的研究见解。我们探讨铁稳态在恢复正常脑脊液循环和稳定最佳脑生理功能中的作用，以减轻SAH后的早期脑损伤和迟发性神经功能损害，从而推动目前对SAH管理的认识。
