Advancements in neuromonitoring for predicting cerebral vasospasm in aneurysmal subarachnoid hemorrhage using near-infrared spectroscopy: an observational study and review of the literature.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH), a severe form of hemorrhagic stroke, poses significant diagnostic and management challenges, particularly in predicting and managing cerebral vasospasm and delayed cerebral ischemia. This study explores the predictive value of near-infrared spectroscopy (NIRS) in high-grade aSAH patients.

Material and methods: This observational study included 16 high-grade aSAH patients treated at a single institution from June 2020 to November 2023. Neuromonitoring incorporated daily transcranial Doppler and continuous NIRS, alongside routine computed tomography perfusion. The primary endpoint was the occurrence of major cerebral vasospasms detected by digital subtraction angiography preceded by a decrease in regional oxygen saturation as indicated by NIRS.

Results: Among the participants, vasospasms were most prevalent in the internal carotid artery (56.3%), followed by the middle cerebral artery (50%). NIRS detected alterations in 43.8% of the cohort, with 25% occurring before vasospasm onset. A correlation between early NIRS alterations and specific vasospasm locations was identified.

Conclusions: Conclusions: While NIRS shows potential for continuous, non-invasive monitoring of cerebral oxygenation, its utility in predicting vasospasms is limited. The findings underscore the importance of integrating NIRS with other neuromonitoring modalities to enhance predictive accuracy and patient management in aSAH. Large-scale studies are necessary to establish protocols and intervention thresholds.