Cervical sympathectomy to treat cerebral vasospasm: a scoping review.
Abstract
<h4>Background/importance</h4>Delayed cerebral ischemia (DCI) is the second-leading
cause of death and disability in patients with aneurysmal subarachnoid hemorrhage
(aSAH), and is associated with cerebral arterial vasospasm (CAV). Current treatments
for CAV are expensive, invasive, and have limited efficacy. Cervical sympathetic block
(CSB) is an underappreciated, but potentially highly effective therapy for CAV.<h4>Objective</h4>To
provide a comprehensive review of the preclinical and human literature pertinent to
CSB in the context of CAV.<h4>Evidence review</h4>This study followed Preferred Reporting
Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.
We conducted a literature search using Embase, PubMed, Cochrane Database of Systematic
Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science
until February 2022, to identify abstracts, conference proceedings, and full-text
papers pertinent to cervical sympathectomy and CAV in animal/adult patients.<h4>Findings</h4>We
included six human and six experimental studies. Human studies were mostly prospective
observational, except one retrospective and one randomized clinical trial, and used
various imaging modalities to measure changes in arterial diameter after the block.
Studies that used digital subtraction angiography showed an improvement in cerebral
perfusion without change in vessel diameter. Transcranial Doppler studies found an
approximately 15% statistically significant decrease in velocities consistent with
arterial vasodilatation. Overall, the results suggest an increase in cerebral arterial
diameter and neurological improvement in patients receiving a CSB. Animal studies
demonstrate that sympathetic system ablation vasodilates cerebral vasculature and
decreases the incidence of symptomatic vasospasm.<h4>Conclusions</h4>This scoping
review suggests that CSB may be a viable option for treatment and prevention of CAV/DCI
in patients with aSAH, although the included studies were heterogeneous, mostly observational,
and with a small sample size. Further research is needed to standardize the technique
and prove its effectiveness to treat patients suffering of CAV/DCI after aSAH.
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https://hdl.handle.net/10161/26270Published Version (Please cite this version)
10.1136/rapm-2022-103999Publication Info
Bombardieri, Anna Maria; Heifets, Boris D; Treggiari, Miriam; Albers, Gregory W; Steinberg,
Gary K; & Heit, Jeremy J (2022). Cervical sympathectomy to treat cerebral vasospasm: a scoping review. Regional anesthesia and pain medicine. pp. rapm-2022-103999. 10.1136/rapm-2022-103999. Retrieved from https://hdl.handle.net/10161/26270.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Miriam Treggiari
Paul G. Barash Distinguished Professor of Anesthesiology

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