Cent Eur Neurosurg 2005; 66(2): 79-91
DOI: 10.1055/s-2005-836479
Consensus Statement

© Georg Thieme Verlag Stuttgart · New York

Empfehlungen zum Management der aneurysmatischen Subarachnoidalblutung

Sektion vaskuläre Neurochirurgie der Deutschen Gesellschaft für Neurochirurgie und Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft für Anästhesiologie und IntensivmedizinRecommendations for the Management of Patients with Aneurysmal Subarachnoid HemorrhageA. Raabe1 , J. Beck1 , J. Berkefeld2 , W. Deinsberger3 , J. Meixensberger4 , P. Schmiedek5 , V. Seifert1 , H. Steinmetz6 , A. Unterberg7 , P. Vajkoczy5 , C. Werner8
  • 1Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Germany
  • 2Institut für Neuroradiologie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Germany
  • 3Neurochirurgische Klinik, Universitätsklinikum Gießen, Germany
  • 4Neurochirurgische Klinik, Universität Leipzig, Germany
  • 5Neurochirurgische Klinik, Klinikum Mannheim, Germany
  • 6Klinik für Neurologie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Germany
  • 7Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Germany
  • 8Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität Mainz, Germany
Further Information

Publication History

Publication Date:
22 April 2005 (online)


Die aneurysmatische Subarachnoidalblutung ist ein Krankheitsbild, das durch häufige primäre und sekundäre Komplikationen gekennzeichnet ist, die neurochirurgischen Interventionen bedürfen, um eine sekundäre Hirnschädigung zu vermeiden. Es ist Ziel der vorliegenden Arbeit, den aktuellen Stand der Datenlage für die einzelnen Therapiemodalitäten der Subarachnoidalblutung wiederzugeben, die im Rahmen des stationären Managements zur Anwendung kommen. Soweit möglich, erfolgt dabei eine Abstufung der Therapieempfehlungen entsprechend der Kriterien der evidenzbasierten Medizin. Die vorliegenden Empfehlungen wurden gemeinsam von der Sektion vaskuläre Neurochirurgie der Deutschen Gesellschaft für Neurochirurgie und dem Wissenschaftlichen Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin erarbeitet.


After SAH, primary and secondary complications are frequent and often require neurosurgical interventions to avoid secondary brain damage. The authors of the present paper have summarized the available data about the treatment modalities often used for patients with SAH. The present recommendations have been developed as a neurosurgical and neuroanestesiological consensus. Evidence from prospective, randomized, double blind, placebo-controlled studies support grade A recommendations (standard) for the prophylaxis and treatment of cerebral vasospasm with oral Nimodipine in good grade patients. For intravenous Nimodipine or for oral nimodipine treatment in poor grade patients, available data only support grade C recommendations (options). Despite the lack of data supporting standards (grade A) or guidelines (grade B), avoidance and rigorous treatment of hypotension and hypovolemia remains the mainstay in the prophylaxis and treatment of a delayed ischemic neurological deficit (DIND). Prophylactic hypervolemia or prophylactic hypertension and hypervolemia was shown to be ineffective in reducing symptomatic vasospasm and improving outcome (grade B). Therapeutic hypertensive hypervolemic hemodilution is recommended as a treatment of symptomatic vasospasm but no prospective studies are available (grade C recommendation). Suggested target values for moderate triple-H-therapy are CPP 80- 120 mmHg (MAP 90-130), CVP > 7 mmHg and Hk 0.25-0.40. Balloon angioplasty should be considered for treatment of DIND cause by focal, proximal cerebral vasospasm. There is no evidence supporting the routine use of antifibrinolytica, steroids or anticonvulsive prophylaxis. Clinical data indicate that current prophylaxis and treatment of cerebral vasospasm is still insufficient and aggressive triple-H-therapy is associated with an increased incidence of complications.


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Prof. Dr. med. Andreas Raabe

Klinik und Poliklinik für Neurochirurgie · Johann-Wolfgang-Goethe-Universität

Schleusenweg 2-16

60528 Frankfurt am Main


Phone: +49/69/63 01 59 39

Fax: +49/69/63 01 71 75

Email: A.Raabe@em.uni-frankfurt.de