Percutaneous Intraspinal Navigation
We therefore plan initially to study 20 patients who present with severe aneurysmal subarachnoid hemorrhage who fall into a risk category making meaningful survival with conventional treatment highly unlikely. These patients may undergo coil occlusion of their aneurysm in the angiography suite if requested by their family. While still in the angiography suite, they will be placed on their stomach (prone). A lumbar puncture will be performed and a small tube (sheath) will be placed. A small catheter will be placed into the sheath and advanced up the space around the spinal cord using the PIN technique into the area of the dense subarachnoid blood in the brain. The area will be rinsed (lavaged) with a saline and glucose rinse that is similar in concentration to that of the normal fluid (CSF) surrounding the brain. The fluid will be drained back out the sheath until the fluid is clear or a maximum of two hours. The neurosurgical and neuroanesthesia team will do strict monitoring of the pressures in the brain. Patients enrolled in this study are severely impaired as entry criteria. Should the patient’s condition worsen during the procedure, the lavage will be discontinued and the patient will have an immediate CT scan to assess for a new subarachnoid hemorrhage. In the absence of new bleeding, the procedure will resume. A CT scan will be performed when the lavage is complete. This will be used to evaluate the efficacy. The patient will resume standard care for a severe aneurismal subarachnoid hemorrhage at this point.
1. Aneurysmal Subarachnoid hemorrhage ( Hunt/Hess grad 3 or greater)
2. >17 years of age