Open Access

Christina Wolfert, Björn Sommer, Andreas Raabe, Ehab Shiban

• Background: Based on the current guidelines, there is no clear consensus on best clinical management modalities concerning cerebral vasospasm prophylaxis (CVP) and follow-up imaging for perimesencephalic non-aneurysmal subarachnoid hemorrhage (NASAH). This survey aims to evaluate the incidence of NASAH patients treated annually as well as the estimated complication rate. Methods: The survey was conducted on an online platform and distributed through the Vascular Section of the European Association of Neurosurgical Societies (EANS). General information about the hospital, the employees’ status and the NASAH patients’ treatment were gathered. Encompassing three clinical vignettes of NASAH with the initial CT-scans, questioning the in-hospital treatment including initial observation, blood pressure management, CVP and the need for digital subtraction angiography (DSA). The case vignettes are depicted in picture 1. Results: Thirty-two questionnaires were answered from eighteen differentBackground: Based on the current guidelines, there is no clear consensus on best clinical management modalities concerning cerebral vasospasm prophylaxis (CVP) and follow-up imaging for perimesencephalic non-aneurysmal subarachnoid hemorrhage (NASAH). This survey aims to evaluate the incidence of NASAH patients treated annually as well as the estimated complication rate. Methods: The survey was conducted on an online platform and distributed through the Vascular Section of the European Association of Neurosurgical Societies (EANS). General information about the hospital, the employees’ status and the NASAH patients’ treatment were gathered. Encompassing three clinical vignettes of NASAH with the initial CT-scans, questioning the in-hospital treatment including initial observation, blood pressure management, CVP and the need for digital subtraction angiography (DSA). The case vignettes are depicted in picture 1. Results: Thirty-two questionnaires were answered from eighteen different countries. Most questionnaires were filled out by departments located in Italy (n=6; 18.8%) and Greece (n=4; 12.5%), followed by the United Kingdom (n=3; 9.4%). The answers were most often provided from employees of University Hospitals (n=27; 84.4%). Nearly half of the departments reported an annual caseload of more than 2000 patients (n=14; 43.7%), whereof the remaining n=18 reported annual caseloads less than 2000 patients (56.3%). Up to five NASAH cases annually were reported by n=10 (31.3%), another 12 (37.4%) treat more than 20 cases in the same time period. In case of a negative DSA, a second one is performed in most of the centers (n=25; 78.1%). With regard to the three different case studies, most centers admit their patients (case 1) to the regular ward (n=17, 51.5%), while only n=9 (27.3%) in the third case. Non-invasive blood pressure management is performed in n=24 (72.7%) in the first case, compared to n=18 (54.5%) in the third. In the third case, most centers perform a CVP (n=15; 45.5%), in comparison to n=8 (24.2%) in the first case. Conclusions: This study confirms the inconclusive treatment of NASAH throughout the EANS members. Furthermore, it depicts that the amount of hyperdensity in the first native CT scan influences the treatment decision. However, clear intercontinental differences cannot be worked out based on the low numbers.…