Feasibility of stereotactic catheter ventriculocisternostomy for cisternal lavage therapy in patients with subarachnoid hemorrhage.

Objective: Delayed cerebral infarction (DCI) confers considerable morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Available prevention strategies are insufficient. Cisternal blood clearance by stereotactic catheter ventriculocisternostomy (STX-VCS) and cisternal lavage therapy is a novel concept for DCI prevention. Here, we assess the general feasibility, pitfalls and imaging requirements of STX-VCS after aSAH.

Methods: 73 aSAH patients admitted between 2008 and 2015 with appropriate imaging for simulation of stereotactic procedures were included. Surgical feasibility of a transventricular trajectory to the basal cisterns was assessed.

Results: Transventricular catheter access to the basal cisterns was feasible in 94% of cases. In 6% vascular obstacles precluded a transventricular approach and access to the basal cisterns could be simulated via a transparenchymal trajectory. CT-artifacts that interfered with stereotactic planning were observed in 58% after coiling and 5% after clipping. In these cases stereotactic planning was enabled by MRI. Logistic regression of aneurysm size and distance-to-target allowed for precise prediction whether MRI was required for stereotactic planning of STX-VCS after coiling.

Conclusions: Stereotactic catheter access to the basal cisterns after aSAH appears to be generally feasible. Coil artifacts compromising CT-based planning can be precisely anticipated and planning enabled by MRI.