A review of the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

BACKGROUND: Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysm subarachnoid haemorrhage (aSAH). OBJECTIVE: To define the scope of the problem and review key treatment strategies that have shaped the way cerebral vasospasm is managed in the contemporary era. METHODS: A literature search of cerebral vasospasm management after aneurysmal subarachnoid haemorrhage was performed. RESULTS: Recent advances in neuroimaging have led to an improved detection of vasospasm, but established treatment guidelines including haemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centres. Experimental research in SAH continues to identify novel targets for therapy. CONCLUSIONS: Proactive and preventative strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.