A review of the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

BACKGROUND: Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysm subarachnoid haemorrhage (aSAH). OBJECTIVE: To define the scope of the problem and review key treatment strategies that have shaped the way cerebral vasospasm is managed in the contemporary era. METHODS: A literature search of cerebral vasospasm management after aneurysmal subarachnoid haemorrhage was performed. RESULTS: Recent advances in neuroimaging have led to an improved detection of vasospasm, but established treatment guidelines including haemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centres. Experimental research in SAH continues to identify novel targets for therapy. CONCLUSIONS: Proactive and preventative strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV

Vertebroplasty for acute painful osteoporotic vertebral compression fractures: an update

Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high-quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham-controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs