{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:26Z","timestamp":1792806146583,"version":"4.5.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The current definition of delayed cerebral ischemia (DCI) is based on clinical characteristics precluding its use in patients with poor-grade subarachnoid hemorrhage (SAH). Additional concepts to evaluate the unconscious patient are required. Invasive neuromonitoring (INM) may allow timely detection of metabolic and oxygenation crises before irreversible damage has occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors present a cohort analysis of all consecutive SAH patients referred to a single tertiary care center between 2010 and 2018. The cohort (n = 190) was split into two groups: one before (n = 96) and one after (n = 94) the introduction of INM in 2014. A total of 55 poor-grade SAH patients were prospectively monitored using parenchymal oxygen saturation measurement and cerebral microdialysis. The primary outcome was the Glasgow Outcome Scale\u2013Extended (GOSE) score after 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>With neuromonitoring, the first DCI event was detected earlier (mean 2.2 days, p = 0.002). The overall rate of DCI-related infarctions decreased significantly (from 44.8% to 22.3%; p = 0.001) after the introduction of invasive monitoring. After 12 months, a higher rate of favorable outcome was observed in the post-INM group, compared to the pre-INM group (53.8% vs 39.8%), with a significant difference in the GOSE score distribution (OR 4.86, 95% CI \u22121.17 to \u22120.07, p = 0.028).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In this cohort analysis of poor-grade SAH patients, the introduction of INM and the extension of the classic DCI definition toward a functional dimension resulted in an earlier detection and treatment of DCI events. This led to an overall decrease in DCI-related infarctions and an improvement in outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.3.jns20375","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T03:42:19Z","timestamp":1589514139000},"page":"1527-1534","source":"Crossref","is-referenced-by-count":52,"title":["Invasive neuromonitoring with an extended definition of delayed cerebral ischemia is associated with improved outcome after poor-grade subarachnoid hemorrhage"],"prefix":"10.3171","volume":"134","author":[{"given":"Michael","family":"Veldeman","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid","family":"Albanna","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Weiss","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"Conzen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias Philip","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henna","family":"Schulze-Steinen","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wiesmann","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Clusmann","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit Alexander","family":"Schubert","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2918","DOI":"10.1161\/STROKEAHA.110.586826","article-title":"Cost of illness in subarachnoid hemorrhage: a German longitudinal study","volume":"41","author":"Dodel\n \nR","year":"2010","unstructured":"Dodel\n \nR\n\n, \n\nWinter\n \nY\n\n, \n\nRingel\n \nF\n\n, \n\n\n \nCost of illness in subarachnoid hemorrhage: a German longitudinal study\n. \nStroke\n. \n2010\n;\n41\n(\n12\n):\n2918\n\u2013\n2923\n.\n10.1161\/STROKEAHA.110.586826"},{"issue":"7","key":"b2","series-title":"J Cereb Blood Flow Metab","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1038\/jcbfm.2011.56","article-title":"Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage","volume":"31","author":"Vergouwen\n \nMD","year":"2011","unstructured":"Vergouwen\n \nMD\n\n, \n\nEtminan\n \nN\n\n, \n\nIlodigwe\n \nD\n\n, \n\nMacdonald\n \nRL\n\n\n. \nLower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage\n. \nJ Cereb Blood Flow Metab\n. \n2011\n;\n31\n(\n7\n):\n1545\n\u2013\n1553\n.\n10.1038\/jcbfm.2011.5621505477"},{"issue":"1","key":"b3","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1161\/STROKEAHA.114.006498","article-title":"Origins of the concept of vasospasm","volume":"47","author":"Macdonald\n \nRL","year":"2016","unstructured":"Macdonald\n \nRL\n\n\n. \nOrigins of the concept of vasospasm\n. \nStroke\n. \n2016\n;\n47\n(\n1\n):\ne11\n\u2013\ne15\n.\n10.1161\/STROKEAHA.114.00649826337970"},{"issue":"7","key":"b4","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/S1474-4422(11)70108-9","article-title":"Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2)","volume":"10","author":"Macdonald\n \nRL","year":"2011","unstructured":"Macdonald\n \nRL\n\n, \n\nHigashida\n \nRT\n\n, \n\nKeller\n \nE\n\n, \n\n\n \nClazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2)\n. \nLancet Neurol\n. \n2011\n;\n10\n(\n7\n):\n618\n\u2013\n625\n.\n2164065110.1016\/S1474-4422(11)70108-9"},{"issue":"6674","key":"b5","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1136\/bmj.298.6674.636","article-title":"Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial","volume":"298","author":"Pickard\n \nJD","year":"1989","unstructured":"Pickard\n \nJD\n\n, \n\nMurray\n \nGD\n\n, \n\nIllingworth\n \nR\n\n, \n\n\n \nEffect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial\n. \nBMJ\n. \n1989\n;\n298\n(\n6674\n):\n636\n\u2013\n642\n.\n10.1136\/bmj.298.6674.6362496789"},{"issue":"8","key":"b6","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.1161\/01.STR.0000133132.76983.8e","article-title":"Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage","volume":"35","author":"Rabinstein\n \nAA","year":"2004","unstructured":"Rabinstein\n \nAA\n\n, \n\nFriedman\n \nJA\n\n, \n\nWeigand\n \nSD\n\n, \n\n\n \nPredictors of cerebral infarction in aneurysmal subarachnoid hemorrhage\n. \nStroke\n. \n2004\n;\n35\n(\n8\n):\n1862\n\u2013\n1866\n.\n1521815610.1161\/01.STR.0000133132.76983.8e"},{"issue":"6","key":"b7","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1161\/STROKEAHA.106.477976","article-title":"Impairment of cerebral perfusion and infarct patterns attributable to vasospasm after aneurysmal subarachnoid hemorrhage: a prospective MRI and DSA study","volume":"38","author":"Weidauer\n \nS","year":"2007","unstructured":"Weidauer\n \nS\n\n, \n\nLanfermann\n \nH\n\n, \n\nRaabe\n \nA\n\n, \n\n\n \nImpairment of cerebral perfusion and infarct patterns attributable to vasospasm after aneurysmal subarachnoid hemorrhage: a prospective MRI and DSA study\n. \nStroke\n. \n2007\n;\n38\n(\n6\n):\n1831\n\u2013\n1836\n.\n1744642510.1161\/STROKEAHA.106.477976"},{"issue":"3","key":"b8","series-title":"Microcirculation","doi-asserted-by":"publisher","first-page":"e12516","DOI":"10.1111\/micc.12516","article-title":"Capillary flow disturbances after experimental subarachnoid hemorrhage: a contributor to delayed cerebral ischemia?","volume":"26","author":"Anzabi\n \nM","year":"2019","unstructured":"Anzabi\n \nM\n\n, \n\nAngleys\n \nH\n\n, \n\nAamand\n \nR\n\n, \n\n\n \nCapillary flow disturbances after experimental subarachnoid hemorrhage: a contributor to delayed cerebral ischemia?\n \nMicrocirculation\n. \n2019\n;\n26\n(\n3\n):\ne12516\n.\n10.1111\/micc.1251630431201"},{"issue":"11","key":"b9","series-title":"J Cereb Blood Flow Metab","doi-asserted-by":"publisher","first-page":"3625","DOI":"10.1177\/0271678X16686595","article-title":"Inversion of neurovascular coupling after subarachnoid hemorrhage in vivo","volume":"37","author":"Balbi\n \nM","year":"2017","unstructured":"Balbi\n \nM\n\n, \n\nKoide\n \nM\n\n, \n\nWellman\n \nGC\n\n, \n\nPlesnila\n \nN\n\n\n. \nInversion of neurovascular coupling after subarachnoid hemorrhage in vivo\n. \nJ Cereb Blood Flow Metab\n. \n2017\n;\n37\n(\n11\n):\n3625\n\u2013\n3634\n.\n10.1177\/0271678X1668659528112024"},{"issue":"3","key":"b10","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1161\/STROKEAHA.117.020028","article-title":"Microvasospasms after experimental subarachnoid hemorrhage do not depend on endothelin A receptors","volume":"49","author":"Liu\n \nH","year":"2018","unstructured":"Liu\n \nH\n\n, \n\nDienel\n \nA\n\n, \n\nSch\u00f6ller\n \nK\n\n, \n\n\n \nMicrovasospasms after experimental subarachnoid hemorrhage do not depend on endothelin A receptors\n. \nStroke\n. \n2018\n;\n49\n(\n3\n):\n693\n\u2013\n699\n.\n10.1161\/STROKEAHA.117.020028"},{"issue":"10","key":"b11","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.1161\/STROKEAHA.115.006353","article-title":"Are we barking up the wrong vessels? Cerebral microcirculation after subarachnoid hemorrhage","volume":"46","author":"Terpolilli\n \nNA","year":"2015","unstructured":"Terpolilli\n \nNA\n\n, \n\nBrem\n \nC\n\n, \n\nB\u00fchler\n \nD\n\n, \n\nPlesnila\n \nN\n\n\n. \nAre we barking up the wrong vessels? Cerebral microcirculation after subarachnoid hemorrhage\n. \nStroke\n. \n2015\n;\n46\n(\n10\n):\n3014\n\u2013\n3019\n.\n10.1161\/STROKEAHA.115.00635326152299"},{"issue":"10","key":"b12","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1161\/STROKEAHA.110.589275","article-title":"Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group","volume":"41","author":"Vergouwen\n \nMD","year":"2010","unstructured":"Vergouwen\n \nMD\n\n, \n\nVermeulen\n \nM\n\n, \n\nvan Gijn\n \nJ\n\n, \n\n\n \nDefinition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group\n. \nStroke\n. \n2010\n;\n41\n(\n10\n):\n2391\n\u2013\n2395\n.\n2079837010.1161\/STROKEAHA.110.589275"},{"key":"b13","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"134","DOI":"10.3389\/fneur.2014.00134","article-title":"Monitoring in neurointensive care\u2014the challenge to detect delayed cerebral ischemia in high-grade aneurysmal SAH","volume":"5","author":"Sarrafzadeh\n \nAS","year":"2014","unstructured":"Sarrafzadeh\n \nAS\n\n, \n\nVajkoczy\n \nP\n\n, \n\nBijlenga\n \nP\n\n, \n\nSchaller\n \nK\n\n\n. \nMonitoring in neurointensive care\u2014the challenge to detect delayed cerebral ischemia in high-grade aneurysmal SAH\n. \nFront Neurol\n. \n2014\n;\n5\n:\n134\n.\n10.3389\/fneur.2014.0013425101052"},{"issue":"12","key":"b14","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1007\/s00234-015-1585-6","article-title":"Reduced-dose CT protocol for the assessment of cerebral vasospasm","volume":"57","author":"Bricout\n \nN","year":"2015","unstructured":"Bricout\n \nN\n\n, \n\nEstrade\n \nL\n\n, \n\nBoustia\n \nF\n\n, \n\n\n \nReduced-dose CT protocol for the assessment of cerebral vasospasm\n. \nNeuroradiology\n. \n2015\n;\n57\n(\n12\n):\n1211\n\u2013\n1218\n.\n10.1007\/s00234-015-1585-626315026"},{"issue":"suppl 2","key":"b15","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"S148","DOI":"10.1007\/s12028-014-0035-3","article-title":"International multidisciplinary consensus conference on multimodality monitoring: cerebral metabolism","volume":"21","author":"Hutchinson\n \nP","year":"2014","unstructured":"Hutchinson\n \nP\n\n, \n\nO\u2019Phelan\n \nK\n\n\n. \nInternational multidisciplinary consensus conference on multimodality monitoring: cerebral metabolism\n. \nNeurocrit Care\n. \n2014\n;\n21\n(\nsuppl 2\n):\nS148\n\u2013\nS158\n.\n2520867310.1007\/s12028-014-0035-3"},{"issue":"6","key":"b16","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1093\/neuros\/nyw132","article-title":"Endovascular rescue therapies for refractory vasospasm after subarachnoid hemorrhage: a prospective evaluation study using multimodal, continuous event neuromonitoring","volume":"80","author":"Albanna\n \nW","year":"2017","unstructured":"Albanna\n \nW\n\n, \n\nWeiss\n \nM\n\n, \n\nM\u00fcller\n \nM\n\n, \n\n\n \nEndovascular rescue therapies for refractory vasospasm after subarachnoid hemorrhage: a prospective evaluation study using multimodal, continuous event neuromonitoring\n. \nNeurosurgery\n. \n2017\n;\n80\n(\n6\n):\n942\n\u2013\n949\n.\n10.1093\/neuros\/nyw13228201539"},{"key":"b17","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"136","DOI":"10.3389\/fneur.2019.00136","article-title":"Endovascular rescue treatment for delayed cerebral ischemia after subarachnoid hemorrhage is safe and effective","volume":"10","author":"Weiss\n \nM","year":"2019","unstructured":"Weiss\n \nM\n\n, \n\nConzen\n \nC\n\n, \n\nMueller\n \nM\n\n, \n\n\n \nEndovascular rescue treatment for delayed cerebral ischemia after subarachnoid hemorrhage is safe and effective\n. \nFront Neurol\n. \n2019\n;\n10\n:\n136\n.\n3085881810.3389\/fneur.2019.00136"},{"issue":"4","key":"b18","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1136\/jnnp.44.4.285","article-title":"Disability after severe head injury: observations on the use of the Glasgow Outcome Scale","volume":"44","author":"Jennett\n \nB","year":"1981","unstructured":"Jennett\n \nB\n\n, \n\nSnoek\n \nJ\n\n, \n\nBond\n \nMR\n\n, \n\nBrooks\n \nN\n\n\n. \nDisability after severe head injury: observations on the use of the Glasgow Outcome Scale\n. \nJ Neurol Neurosurg Psychiatry\n. \n1981\n;\n44\n(\n4\n):\n285\n\u2013\n293\n.\n645395710.1136\/jnnp.44.4.285"},{"issue":"8","key":"b19","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1089\/neu.1998.15.573","article-title":"Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use","volume":"15","author":"Wilson\n \nJT","year":"1998","unstructured":"Wilson\n \nJT\n\n, \n\nPettigrew\n \nLE\n\n, \n\nTeasdale\n \nGM\n\n\n. \nStructured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use\n. \nJ Neurotrauma\n. \n1998\n;\n15\n(\n8\n):\n573\n\u2013\n585\n.\n10.1089\/neu.1998.15.5739726257"},{"issue":"1","key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/2012.9.JNS111383","article-title":"Sliding dichotomy compared with fixed dichotomization of ordinal outcome scales in subarachnoid hemorrhage trials","volume":"118","author":"Ilodigwe\n \nD","year":"2013","unstructured":"Ilodigwe\n \nD\n\n, \n\nMurray\n \nGD\n\n, \n\nKassell\n \nNF\n\n, \n\n\n \nSliding dichotomy compared with fixed dichotomization of ordinal outcome scales in subarachnoid hemorrhage trials\n. \nJ Neurosurg\n. \n2013\n;\n118\n(\n1\n):\n3\n\u2013\n12\n.\n2303914510.3171\/2012.9.JNS111383"},{"issue":"4","key":"b21","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1161\/STROKEAHA.110.597914","article-title":"Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects","volume":"42","author":"Vergouwen\n \nMD","year":"2011","unstructured":"Vergouwen\n \nMD\n\n, \n\nIlodigwe\n \nD\n\n, \n\nMacdonald\n \nRL\n\n\n. \nCerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects\n. \nStroke\n. \n2011\n;\n42\n(\n4\n):\n924\n\u2013\n929\n.\n2131106210.1161\/STROKEAHA.110.597914"},{"issue":"10","key":"b22","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"e1043","DOI":"10.1097\/CCM.0000000000002653","article-title":"Safety hazards during intrahospital transport: a prospective observational study","volume":"45","author":"Bergman\n \nLM","year":"2017","unstructured":"Bergman\n \nLM\n\n, \n\nPettersson\n \nME\n\n, \n\nChaboyer\n \nWP\n\n, \n\n\n \nSafety hazards during intrahospital transport: a prospective observational study\n. \nCrit Care Med\n. \n2017\n;\n45\n(\n10\n):\ne1043\n\u2013\ne1049\n.\n10.1097\/CCM.000000000000265328787292"},{"issue":"3","key":"b23","series-title":"Int J Stroke","first-page":"375","article-title":"HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA): a randomized single-blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage","volume":"9","author":"Gathier\n \nCS","year":"2014","unstructured":"Gathier\n \nCS\n\n, \n\nvan den Bergh\n \nWM\n\n, \n\nSlooter\n \nAJ\n\n\n. \nHIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA): a randomized single-blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage\n. \nInt J Stroke\n. \n2014\n;\n9\n(\n3\n):\n375\n\u2013\n380\n.\n23692645"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/5\/article-p1527.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/5\/article-p1527.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/5\/article-p1527.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:51:02Z","timestamp":1792803062000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/5\/article-p1527.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":23,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2020.3.jns20375","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}