International Circulation: What are some of the main developments in the treatment of subarachnoid hemorrhage (SAH) therapy?
《国际循环》：蛛网膜下腔出血的治疗有哪些主要进展?
Dr. Wartenberg: It has been a very active and emerging field， particularly in the area of delayed cerebral ischemia. The thought has shifted from having vasospasm as a target of medical and interventional therapies to preventing late cerebral ischemia by other neuroprotective strategies and to preventing early brain injury. The question is how to target early brain injury after SAH， as you have to be very quick in the use of neuroprotective agents. This will be the target in the future. Other developments include management of medical complications， such as inducing normothermia. More studies will also be conducted on blood transfusion for anemia and hyperglycemia.
Wartenberg博士：蛛网膜下腔出血（SAH）的治疗是一个非常活跃的、新兴的科研领域，迟发性脑缺血的研究尤其如此。当前人们的注意力已经从把血管痉挛作为药物和干预治疗的靶点转向通过其他神经保护策略预防迟发性脑缺血的发生，还有预防早期脑损伤。问题是SAH发生后如何早期针对脑损伤，因为要非常快速地应用神经保护药物。这是未来研究的焦点。SAH治疗领域的其他进展包括采取使体温恢复正常等方法来治疗SAH的并发症。
　IC: In China， patients suspected of suffering a stroke will be sent to the neural medicine department instead of to neurosurgery. Do you have any advice for quickly diagnosing when a patient would be in need of surgery?
《国际循环》：在中国，疑诊为卒中的患者会被收入神经内科，而不是收入神经外科。当卒中患者需要外科治疗时，对于快速诊断你有哪些建议？
Dr. Wartenberg: It is always best to have a neurologist or neurointensive care team in place， because from the outside， you cannot know if the patients will eventually need surgery or not. For example， the ischemic stroke patient will of course initially be treated medically. Hopefully， the ischemic stroke patient will get thrombolysis in some sort of monitored setting including monitoring for glucose， temperature， blood pressure， etc. Later， the patient may end up developing severe brain swelling， a so called malignant middle cerebral artery (MCA) infarction， which would require a decompressive craniotomy (e.g. removing the skull from the affected brain side). It is similar with intracerebral hemorrhage. When a patient comes in， one does not know if the patient needs a craniotomy to relieve intracranial hypertension. So the best would be to combine the two departments and work with a multidisciplinary approach where patients could be treated medically and have the option of early availability of neurosurgery.
　Wartenberg博士：最好是有神经内科或神经重症监护医疗团队准备就绪，因为单从表面来看，你无法知道患者是否最终会需要外科治疗。例如，缺血性卒中患者当然会首先接受药物治疗。在理想情况下，缺血性卒中患者会接受溶栓治疗，在接受血糖、血压和体温等指标监测的情况下。随后，患者可能发生严重的脑水肿，即所谓的恶性大脑中动脉脑梗死，患者需要接受去瓣减压术（即去除受累脑区相应的颅骨）。这与脑出血所接受的治疗是一致的。当患者就诊时，医生无法知道患者是否将需要接受去瓣减压术来缓解颅内高压。因此，最理想的作法是整合神经内科和神经重症监护两方面的人员，通过多学科合作的方式工作，患者既能接受药物治疗，也能选择在早期接受外科手术治疗。