{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:28:37Z","timestamp":1793759317143,"version":"4.6.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Stellate ganglion block (SGB) is a commonly used sympathetic nerve block technique that may have benefits for patients with aneurysmal subarachnoid hemorrhage (aSAH) in the early stage. Cerebral vasospasm (CVS), one of the most common complications of aSAH, is accompanied by an abnormal increase in cerebral blood flow velocity (CBFV) and neurological dysfunction. In this pilot study the authors sought to determine the feasibility of early SGB for CVS in aSAH patients by observing the incidence of symptomatic CVS.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Prior to receiving surgical treatment, patients with aSAH were randomly assigned to the SGB group or the non-SGB group. The primary outcome was the incidence of symptomatic CVS within 14 \u00b1 2 days after the onset of aSAH. As a higher CBFV is often associated with CVS and a poor prognosis, the mean CBFV of the middle cerebral artery was observed immediately after surgery and on postoperative days 1, 2, 3, 5, and 7. Other secondary outcomes included transcranial Doppler (TCD)\/CTA-type CVS, delayed cerebral ischemia during hospitalization, new cerebral infarction within 3 months, adverse events (AEs), and clinical prognosis.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Symptomatic CVS occurred in 40% of patients in the non-SGB group and in 20% in the SGB group (RR 0.50, 95% CI 0.22\u20131.16). Continuous TCD sonography revealed that the postoperative mean CBFV was lower in the SGB group than in the non-SGB group (F = 3.608, p = 0.02). In addition, the percentages of patients with CVS evaluated by TCD (TCD-CVS) and total new infarctions within 3 months were also significantly lower than those in patients with CVS (TCD-CVS 36.7% vs 70%, RR 0.52, 95% CI 0.31\u20130.89, and total new infarctions 26.7% vs 53.3%, RR 0.50, 95% CI 0.25\u20130.99). In terms of AEs and mortality, there were no significant differences between the two groups.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This pilot study demonstrated for the first time, to the authors\u2019 knowledge, that early SGB is feasible and has the potential to reduce the risk of CVS and improve the prognosis of aSAH. This method may be a new treatment for patients with aSAH that may have more advantages than traditional therapeutic drugs and is worth further study.<\/jats:p>\n \n Clinical trial registration no.: NCT04691271 (\n ClinicalTrials.gov<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.3.jns222567","type":"journal-article","created":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T10:23:18Z","timestamp":1682763798000},"page":"1339-1347","source":"Crossref","is-referenced-by-count":22,"title":["Early stellate ganglion block for improvement of postoperative cerebral blood flow velocity after aneurysmal subarachnoid hemorrhage: results of a pilot randomized controlled trial"],"prefix":"10.3171","volume":"139","author":[{"given":"Youxuan","family":"Wu","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fa","family":"Lin","sequence":"additional","affiliation":[{"name":"Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Bai","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fa","family":"Liang","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minyu","family":"Jian","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunzhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyang","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Chen","sequence":"additional","affiliation":[{"name":"Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruquan","family":"Han","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Stroke","first-page":"1711","article-title":"Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"43","author":"Connolly ES Jr","year":"2012","unstructured":"Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2012;43(6):1711\u20131737."},{"issue":"3","key":"b2","series-title":"Transl Stroke Res","first-page":"428","article-title":"Aneurysmal subarachnoid hemorrhage: the last decade","volume":"12","author":"Neifert SN","year":"2021","unstructured":"Neifert SN, Chapman EK, Martini ML, Aneurysmal subarachnoid hemorrhage: the last decade. Transl Stroke Res. 2021;12(3):428\u2013446."},{"issue":"7","key":"b3","series-title":"J Cereb Blood Flow Metab","first-page":"1545","article-title":"Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage","volume":"31","author":"Vergouwen MD","year":"2011","unstructured":"Vergouwen MD, Etminan N, Ilodigwe D, Macdonald RL. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31(7):1545\u20131553."},{"issue":"1","key":"b4","series-title":"Curr Neuropharmacol","first-page":"65","article-title":"Nimodipine reappraised: an old drug with a future","volume":"18","author":"Carlson AP","year":"2020","unstructured":"Carlson AP, H\u00e4nggi D, Macdonald RL, Shuttleworth CW. Nimodipine reappraised: an old drug with a future. Curr Neuropharmacol. 2020;18(1):65\u201382."},{"issue":"4","key":"b5","series-title":"Expert Opin Investig Drugs","first-page":"313","article-title":"Investigational drugs for vasospasm after subarachnoid hemorrhage","volume":"27","author":"Tallarico RT","year":"2018","unstructured":"Tallarico RT, Pizzi MA, Freeman WD. Investigational drugs for vasospasm after subarachnoid hemorrhage. Expert Opin Investig Drugs. 2018;27(4):313\u2013324."},{"issue":"6","key":"b6","series-title":"J Cereb Blood Flow Metab","first-page":"1443","article-title":"Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","volume":"31","author":"Etminan N","year":"2011","unstructured":"Etminan N, Vergouwen MD, Ilodigwe D, Macdonald RL. Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Cereb Blood Flow Metab. 2011;31(6):1443\u20131451."},{"issue":"2","key":"b7","series-title":"JAMA Psychiatry","first-page":"130","article-title":"Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial","volume":"77","author":"Rae Olmsted KL","year":"2020","unstructured":"Rae Olmsted KL, Bartoszek M, Mulvaney S, Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial. JAMA Psychiatry. 2020;77(2):130\u2013138."},{"issue":"3","key":"b8","series-title":"World J Gastroenterol","first-page":"533","article-title":"Efficacy and safety of stellate ganglion block in chronic ulcerative colitis","volume":"23","author":"Zhao HY","year":"2017","unstructured":"Zhao HY, Yang GT, Sun NN, Kong Y, Liu YF. Efficacy and safety of stellate ganglion block in chronic ulcerative colitis. World J Gastroenterol. 2017;23(3):533\u2013539."},{"issue":"6","key":"b9","series-title":"Lancet Oncol","first-page":"523","article-title":"Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study","volume":"9","author":"Lipov EG","year":"2008","unstructured":"Lipov EG, Joshi JR, Sanders S, Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol. 2008;9(6):523\u2013532."},{"issue":"5","key":"b10","series-title":"Br J Anaesth","first-page":"669","article-title":"Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography","volume":"95","author":"Gupta MM","year":"2005","unstructured":"Gupta MM, Bithal PK, Dash HH, Chaturvedi A, Mahajan RP. Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. Br J Anaesth. 2005;95(5):669\u2013673."},{"issue":"2","key":"b11","series-title":"Pain","first-page":"161","article-title":"Regional sympathetic blockade in primary fibromyalgia","volume":"33","author":"Bengtsson A","year":"1988","unstructured":"Bengtsson A, Bengtsson M. Regional sympathetic blockade in primary fibromyalgia. Pain. 1988;33(2):161\u2013167."},{"issue":"3","key":"b12","series-title":"Compr Physiol","first-page":"1177","article-title":"Autonomic nervous system and immune system interactions","volume":"4","author":"Kenney MJ","year":"2014","unstructured":"Kenney MJ, Ganta CK. Autonomic nervous system and immune system interactions. Compr Physiol. 2014;4(3):1177\u20131200."},{"key":"b13","series-title":"Med Hypotheses","first-page":"110000","article-title":"How does stellate ganglion block alleviate immunologically-linked disorders?","volume":"144","author":"Lipov E","year":"2020","unstructured":"Lipov E, Gluncic V, Luki\u0107 IK, Candido K. How does stellate ganglion block alleviate immunologically-linked disorders? Med Hypotheses. 2020;144:110000."},{"issue":"9","key":"b14","series-title":"Neural Regen Res","first-page":"1991","article-title":"Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke","volume":"17","author":"Li TT","year":"2022","unstructured":"Li TT, Wan Q, Zhang X, Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke. Neural Regen Res. 2022;17(9):1991\u20131997."},{"key":"b15","series-title":"J Clin Anesth","first-page":"149","article-title":"Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients","volume":"37","author":"Chen YQ","year":"2017","unstructured":"Chen YQ, Xie YY, Wang B, Jin XJ. Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients. J Clin Anesth. 2017;37:149\u2013153."},{"issue":"4","key":"b16","series-title":"Stroke","first-page":"961","article-title":"Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage","volume":"34","author":"Treggiari MM","year":"2003","unstructured":"Treggiari MM, Romand JA, Martin JB, Reverdin A, R\u00fcfenacht DA, de Tribolet N. Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. Stroke. 2003;34(4):961\u2013967."},{"issue":"4","key":"b17","series-title":"J Anaesthesiol Clin Pharmacol","first-page":"516","article-title":"Stellate ganglion block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage\u2014a preliminary study","volume":"27","author":"Jain V","year":"2011","unstructured":"Jain V, Rath GP, Dash HH, Bithal PK, Chouhan RS, Suri A. Stellate ganglion block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage\u2014a preliminary study. J Anaesthesiol Clin Pharmacol. 2011;27(4):516\u2013521."},{"issue":"3","key":"b18","series-title":"J Neurosurg","first-page":"773","article-title":"Decrease of blood flow velocity in the middle cerebral artery after stellate ganglion block following aneurysmal subarachnoid hemorrhage: a potential vasospasm treatment?","volume":"133","author":"Wendel C","year":"2020","unstructured":"Wendel C, Scheibe R, Wagner S, Decrease of blood flow velocity in the middle cerebral artery after stellate ganglion block following aneurysmal subarachnoid hemorrhage: a potential vasospasm treatment? J Neurosurg. 2020;133(3):773\u2013779."},{"issue":"10","key":"b19","series-title":"Neuroradiology","first-page":"1701","article-title":"Stellate ganglion block combined with intra-arterial treatment: a \"one-stop shop\" for cerebral vasospasm after aneurysmal subarachnoid hemorrhage-a pilot study","volume":"63","author":"Pileggi M","year":"2021","unstructured":"Pileggi M, Mosimann PJ, Isalberti M, Stellate ganglion block combined with intra-arterial treatment: a \"one-stop shop\" for cerebral vasospasm after aneurysmal subarachnoid hemorrhage-a pilot study. Neuroradiology. 2021;63(10):1701\u20131708."},{"issue":"6","key":"b20","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Transcranial Doppler ultrasonography in neurological surgery and neurocritical care","volume":"47","author":"Bonow RH","year":"2019","unstructured":"Bonow RH, Young CC, Bass DI, Moore A, Levitt MR. Transcranial Doppler ultrasonography in neurological surgery and neurocritical care. Neurosurg Focus. 2019;47(6):E2."},{"issue":"6","key":"b21","series-title":"Stroke","first-page":"1963","article-title":"Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?","volume":"40","author":"Frontera JA","year":"2009","unstructured":"Frontera JA, Fernandez A, Schmidt JM, Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40(6):1963\u20131968."},{"issue":"10","key":"b22","series-title":"Stroke","first-page":"2391","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 MD","year":"2010","unstructured":"Vergouwen MD, Vermeulen M, van Gijn J, 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. Stroke. 2010;41(10):2391\u20132395."},{"issue":"1","key":"b23","series-title":"Trials","first-page":"922","article-title":"Effect of early stellate ganglion block in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (BLOCK-CVS): study protocol for a randomized controlled trial","volume":"23","author":"Jing L","year":"2022","unstructured":"Jing L, Wu Y, Liang F, Effect of early stellate ganglion block in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (BLOCK-CVS): study protocol for a randomized controlled trial. Trials. 2022;23(1):922."},{"issue":"9","key":"b24","series-title":"Stroke","first-page":"2024","article-title":"Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial","volume":"36","author":"Lynch JR","year":"2005","unstructured":"Lynch JR, Wang H, McGirt MJ, Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke. 2005;36(9):2024\u20132026."},{"issue":"5","key":"b25","series-title":"Cell Mol Neurobiol","first-page":"675","article-title":"Inflammatory pathways following subarachnoid hemorrhage","volume":"40","author":"Khey KMW","year":"2020","unstructured":"Khey KMW, Huard A, Mahmoud SH. Inflammatory pathways following subarachnoid hemorrhage. Cell Mol Neurobiol. 2020;40(5):675\u2013693."},{"key":"b26","series-title":"Exp Neurol","first-page":"113535","article-title":"The role of immune inflammation in aneurysmal subarachnoid hemorrhage","volume":"336","author":"Zhang Z","year":"2021","unstructured":"Zhang Z, Fang Y, Lenahan C, Chen S. The role of immune inflammation in aneurysmal subarachnoid hemorrhage. Exp Neurol. 2021;336:113535."},{"key":"b27","series-title":"J Clin Neurosci","first-page":"7","article-title":"Neuroinflammation responses after subarachnoid hemorrhage: a review","volume":"42","author":"Zheng VZ","year":"2017","unstructured":"Zheng VZ, Wong GKC. Neuroinflammation responses after subarachnoid hemorrhage: a review. J Clin Neurosci. 2017;42:7\u201311."},{"issue":"14","key":"b28","series-title":"Int J Mol Sci","first-page":"7355","article-title":"Inflammation and anti-inflammatory targets after aneurysmal subarachnoid hemorrhage","volume":"22","author":"Muhammad S","year":"2021","unstructured":"Muhammad S, H\u00e4nggi D. Inflammation and anti-inflammatory targets after aneurysmal subarachnoid hemorrhage. Int J Mol Sci. 2021;22(14):7355."},{"issue":"8","key":"b29","series-title":"J Cereb Blood Flow Metab","first-page":"916","article-title":"Signaling pathways for early brain injury after subarachnoid hemorrhage","volume":"24","author":"Kusaka G","year":"2004","unstructured":"Kusaka G, Ishikawa M, Nanda A, Granger DN, Zhang JH. Signaling pathways for early brain injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2004;24(8):916\u2013925."},{"issue":"7","key":"b30","series-title":"Lancet Neurol","first-page":"618","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 RL","year":"2011","unstructured":"Macdonald RL, Higashida RT, Keller E, 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). Lancet Neurol. 2011;10(7):618\u2013625."},{"issue":"91","key":"b31","series-title":"Acta Neurochir Suppl","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/978-3-030-04615-6_15","article-title":"Toll-like receptor 4 and tenascin-C signaling in cerebral vasospasm and brain injuries after subarachnoid hemorrhage","volume":"127","author":"Suzuki H","year":"2020","unstructured":"Suzuki H, Fujimoto M, Kawakita F, Toll-like receptor 4 and tenascin-C signaling in cerebral vasospasm and brain injuries after subarachnoid hemorrhage. Acta Neurochir Suppl. 2020;127(91):96."},{"issue":"9","key":"b32","series-title":"Int J Clin Exp Med","first-page":"15630","article-title":"Impacts of stellate ganglion block on plasma NF-\u03baB and inflammatory factors of TBI patients","volume":"8","author":"Yang X","year":"2015","unstructured":"Yang X, Shi Z, Li X, Li J. Impacts of stellate ganglion block on plasma NF-\u03baB and inflammatory factors of TBI patients. Int J Clin Exp Med. 2015;8(9):15630\u201315638."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/5\/article-p1339.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/5\/article-p1339.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/5\/article-p1339.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T06:50:55Z","timestamp":1716015055000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/5\/article-p1339.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":32,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2023.3.jns222567","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}