Contemporary management of aneurysmal subarachnoid hemorrhage in Germany: Results of a survey among 100 neurosurgical departments

OBJECTIVE: To assess the status quo of clinical management in patients with ruptured intracranial aneurysms in Germany. In addition to preferences in vascular treatment (i.e., surgical versus endovascular), the choice of diagnostics and treatment options in the pre- and postprocedural phase is emphasized. METHODS: A standardized questionnaire was used in a postal survey. Participants were representatives of neurosurgical departments in Germany (n = 130, total number of departments). Comparisons between groups of respondents were tested using chi(2) statistics (Fisher's exact test, two-sided). RESULTS: The overall response rate was 77% (n = 100). Preoperative assessment is standard by computed tomography and conventional angiography. Currently, endovascular treatment options are available in 71% of all responding centers. On the basis of self estimates it is projected that 63% of all ruptured aneurysms are treated surgically, whereas 37% are treated endovascularly. For anterior circulation aneurysms, a significantly higher number of respondents commit to routine or frequent use of surgical techniques compared with endovascular treatment options (93 versus 52%, P <= 0.05). In contrast, for posterior circulation aneurysms, endovascular treatment is preferred (24 versus 94%, P <= 0.05). Acute posthemorrhagic hydrocephalus is treated by external ventricular drainage routinely (97%). Doppler sonography, monitoring of cerebral perfusion pressure, and electrophysiology are used by a significant number of respondents. Specific treatment of subarachnoid hemorrhage (SAH) patients includes calcium antagonists (70%), glucocorticosteroids (35%), and hemorheologic agents (30%). CONCLUSION: In Germany, aneurysmal subarachnoid hemorrhage remains a disease in which standardization of clinical management is highest in preoperative diagnostics, intensive care unit monitoring, and postoperative treatment. With respect to currently published guidelines for subarachnoid hemorrhage treatment, compliance is moderate. Preferred treatment for anterior circulation aneurysms is predominantly surgical, whereas endovascular treatment options are preferentially used in aneurysms of the posterior circulation. This survey serves as a basis to analyze future developments in the management of subarachnoid hemorrhage more and internationally.