1. Introduction
intracranial aneurysm, SAH, cerebral infarction, strokes, vasospasm, DCI, pain, cerebral vasospasm, rupture, aneurysmal SAH, Cerebral vasospasm, subarachnoid aneurysmal hemorrhage, cerebral ischemia, infarction
DELAYED CEREBRAL ISCHEMIA, INTRACRANIAL ANEURYSM, STROKES, VASOSPASM, PATHOPHYSIOLOGY, COMPLICATION, SECONDARY, DCI, SUBARACHNOID HEMORRHAGE, CEREBRAL VASOSPASM, SEQUELAE, CEREBRAL INFARCTION, CEREBRAL ISCHEMIA, INFARCTION
The author has passed away.Cerebral vasospasm remains the most frequent and devastating complication after subarachnoid aneurysmal hemorrhage because of secondary cerebral ischemia and its sequelae. The underlying pathophysiology involves vasodilator peptide release (such as CGRP) and nitric oxide depletion at the level of the precapillary sphincters of the cerebral (internal carotid artery network) and dural (external carotid artery network) arteries, which are both innervated by craniofacial autonomic afferents and tightly connected to the trigeminal nerve and trigemino-cervical nucleus complex. We hypothesized that trigeminal nerve modulation could influence the cerebral flow of this vascular network through a sympatholytic effect and decrease the occurrence of vasospasm and its consequences. We conducted a prospective double-blind, randomized controlled pilot trial to compare the effect of 10 days of transcutaneous electrical trigeminal nerve stimulation vs. sham stimulation on cerebral infarction occurrence at 3 months. Sixty patients treated for aneurysmal SAH (World Federation of Neurosurgical Societies scale between 1 and 4) were included. We compared the radiological incidence of delayed cerebral ischemia (DCI) on magnetic resonance imaging (MRI) at 3 months in moderate and severe vasospasm patients receiving trigeminal nerve stimulation (TNS group) vs. sham stimulation (sham group). Our primary endpoint (the infarction rate at the 3-month follow-up) did not significantly differ between the two groups (The subarachnoid hemorrhage (SAH) occurring after the rupture of an intracranial aneurysm represents about 5% of all strokes [In a recent systematic review and meta-analysis, Boulouis et al. [Neurostimulation, which is a validated technique to address chronic refractory pain, has shown clinical effects not only on pain but also on autonomic functions [In this specific context, cerebral vasospasm pathophysiology involves vasodilator peptide release depletion [In clinical practice, to date, stimulation of the trigeminovascular system has never been considered a viable therapeutic option. With this in mind, we designed a single-center, randomized, double-blind proof-of-concept pilot study to compare trigeminal nerve stimulation with sham stimulation in an attempt to decrease the risk of vasospasm-related cerebral infarction in patients with aneurysmal SAH.