{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:07:33Z","timestamp":1770354453932,"version":"3.49.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Multimodal monitoring to guide medical intervention in high-grade aneurysmal subarachnoid hemorrhage (aSAH) is well described. Multimodal monitoring to guide surgical intervention in high-grade aSAH has been less studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      Intracranial pressure (ICP), brain lactate to pyruvate ratio (L\/P ratio), and brain parenchymal oxygen tension (pO\n                      <jats:sub>2<\/jats:sub>\n                      ) were used as surrogates for clinical status in a comatose man after high-grade aSAH. Acute changes in ICP, L\/P ratio, and pO\n                      <jats:sub>2<\/jats:sub>\n                      were used to identify brain injury from both malignant cerebral edema and delayed cerebral ischemia, respectively, and decompressive hemicraniectomy with clot evacuation and intraarterial nimodipine were used to treat these conditions. The patient showed marked improvement in multimodal parameters following each intervention and eventually recovered to a modified Rankin score of 2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In patients with a limited neurological examination due to severe acute brain injury in the setting of aSAH, multimodal monitoring can be used to guide surgical treatment. With prompt, aggressive, maximal medical and surgical interventions, otherwise healthy individuals may retain the capacity for close to full recovery from seemingly catastrophic aSAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22107","type":"journal-article","created":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T06:11:15Z","timestamp":1656915075000},"source":"Crossref","is-referenced-by-count":0,"title":["Multimodal monitoring to guide neurosurgical intervention in high-grade aneurysmal subarachnoid hemorrhage: illustrative case"],"prefix":"10.3171","volume":"3","author":[{"given":"Bradley","family":"Kolb","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Wolfson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Da Silva","sequence":"additional","affiliation":[{"name":"Neurological Sciences, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan A.","family":"Munich","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3389\/fneur.2017.00601","article-title":"Cerebral microdialysis monitoring to improve individualized neurointensive care therapy: an update of recent clinical data","volume":"8","author":"Carteron L","year":"2017","unstructured":"Carteron L, Bouzat P, Oddo M. Cerebral microdialysis monitoring to improve individualized neurointensive care therapy: an update of recent clinical data. Front Neurol. 2017;8:601.10.3389\/fneur.2017.00601"},{"issue":"2","key":"b2","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1007\/s12028-010-9472-9","article-title":"Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage","volume":"14","author":"Helbok R","year":"2011","unstructured":"Helbok R, Madineni RC, Schmidt MJ,  Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage. Neurocrit Care. 2011;14(2):162\u2013167.10.1007\/s12028-010-9472-9"},{"issue":"4","key":"b3","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1136\/jnnp-2016-313766","article-title":"Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage","volume":"88","author":"Patet C","year":"2017","unstructured":"Patet C, Quintard H, Zerlauth JB,  Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2017;88(4):332\u2013338.10.1136\/jnnp-2016-313766"},{"issue":"9","key":"b4","series-title":"Intensive Care Med","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1007\/s00134-015-3930-y","article-title":"Consensus statement from the 2014 International Microdialysis Forum","volume":"41","author":"Hutchinson PJ","year":"2015","unstructured":"Hutchinson PJ, Jalloh I, Helmy A,  Consensus statement from the 2014 International Microdialysis Forum. Intensive Care Med. 2015;41(9):1517\u20131528.10.1007\/s00134-015-3930-y"},{"issue":"2","key":"b5","series-title":"Curr Opin Crit Care","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/MCC.0000000000000798","article-title":"How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage","volume":"27","author":"Rass V","year":"2021","unstructured":"Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Curr Opin Crit Care. 2021;27(2):103\u2013114.10.1097\/MCC.0000000000000798"},{"key":"b6","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"565","DOI":"10.3389\/fneur.2017.00565","article-title":"Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art","volume":"8","author":"Helbok R","year":"2017","unstructured":"Helbok R, Kofler M, Schiefecker AJ,  Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art. Front Neurol. 2017;8:565.10.3389\/fneur.2017.00565"},{"issue":"10","key":"b7","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 MDI","year":"2010","unstructured":"Vergouwen MDI, 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\u20132395.10.1161\/STROKEAHA.110.589275"},{"issue":"11","key":"b8","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3624","DOI":"10.1161\/STROKEAHA.121.034633","article-title":"Invasive multimodal neuromonitoring in aneurysmal subarachnoid hemorrhage: a systematic review","volume":"52","author":"Veldeman M","year":"2021","unstructured":"Veldeman M, Albanna W, Weiss M,  Invasive multimodal neuromonitoring in aneurysmal subarachnoid hemorrhage: a systematic review. Stroke. 2021;52(11):3624\u20133632.10.1161\/STROKEAHA.121.034633"},{"issue":"1","key":"b9","series-title":"Sci Rep","doi-asserted-by":"publisher","first-page":"7466","DOI":"10.1038\/s41598-020-64543-x","article-title":"Double hemispheric microdialysis study in poor-grade SAH patients","volume":"10","author":"Torn\u00e9 R","year":"2020","unstructured":"Torn\u00e9 R, Culebras D, Sanchez-Etayo G,  Double hemispheric microdialysis study in poor-grade SAH patients. Sci Rep. 2020;10(1):7466.10.1038\/s41598-020-64543-x"},{"key":"b1","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3389\/fneur.2017.00601","article-title":"Cerebral microdialysis monitoring to improve individualized neurointensive care therapy: an update of recent clinical data","volume":"8","author":"Carteron L","year":"2017","unstructured":"Carteron L, Bouzat P, Oddo M. Cerebral microdialysis monitoring to improve individualized neurointensive care therapy: an update of recent clinical data. Front Neurol. 2017;8:601.10.3389\/fneur.2017.00601"},{"issue":"2","key":"b2","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1007\/s12028-010-9472-9","article-title":"Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage","volume":"14","author":"Helbok R","year":"2011","unstructured":"Helbok R, Madineni RC, Schmidt MJ,  Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage. Neurocrit Care. 2011;14(2):162\u2013167.10.1007\/s12028-010-9472-9"},{"issue":"4","key":"b3","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1136\/jnnp-2016-313766","article-title":"Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage","volume":"88","author":"Patet C","year":"2017","unstructured":"Patet C, Quintard H, Zerlauth JB,  Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2017;88(4):332\u2013338.10.1136\/jnnp-2016-313766"},{"issue":"9","key":"b4","series-title":"Intensive Care Med","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1007\/s00134-015-3930-y","article-title":"Consensus statement from the 2014 International Microdialysis Forum","volume":"41","author":"Hutchinson PJ","year":"2015","unstructured":"Hutchinson PJ, Jalloh I, Helmy A,  Consensus statement from the 2014 International Microdialysis Forum. Intensive Care Med. 2015;41(9):1517\u20131528.10.1007\/s00134-015-3930-y"},{"issue":"2","key":"b5","series-title":"Curr Opin Crit Care","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/MCC.0000000000000798","article-title":"How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage","volume":"27","author":"Rass V","year":"2021","unstructured":"Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Curr Opin Crit Care. 2021;27(2):103\u2013114.10.1097\/MCC.0000000000000798"},{"key":"b6","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"565","DOI":"10.3389\/fneur.2017.00565","article-title":"Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art","volume":"8","author":"Helbok R","year":"2017","unstructured":"Helbok R, Kofler M, Schiefecker AJ,  Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art. Front Neurol. 2017;8:565.10.3389\/fneur.2017.00565"},{"issue":"10","key":"b7","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 MDI","year":"2010","unstructured":"Vergouwen MDI, 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\u20132395.10.1161\/STROKEAHA.110.589275"},{"issue":"11","key":"b8","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3624","DOI":"10.1161\/STROKEAHA.121.034633","article-title":"Invasive multimodal neuromonitoring in aneurysmal subarachnoid hemorrhage: a systematic review","volume":"52","author":"Veldeman M","year":"2021","unstructured":"Veldeman M, Albanna W, Weiss M,  Invasive multimodal neuromonitoring in aneurysmal subarachnoid hemorrhage: a systematic review. Stroke. 2021;52(11):3624\u20133632.10.1161\/STROKEAHA.121.034633"},{"issue":"1","key":"b9","series-title":"Sci Rep","doi-asserted-by":"publisher","first-page":"7466","DOI":"10.1038\/s41598-020-64543-x","article-title":"Double hemispheric microdialysis study in poor-grade SAH patients","volume":"10","author":"Torn\u00e9 R","year":"2020","unstructured":"Torn\u00e9 R, Culebras D, Sanchez-Etayo G,  Double hemispheric microdialysis study in poor-grade SAH patients. Sci Rep. 2020;10(1):7466.10.1038\/s41598-020-64543-x"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/26\/article-CASE22107.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/26\/article-CASE22107.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/26\/article-CASE22107.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:41:46Z","timestamp":1770302506000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/26\/article-CASE22107.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,27]]},"references-count":18,"journal-issue":{"issue":"26"},"URL":"https:\/\/doi.org\/10.3171\/case22107","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,27]]}}}