Neuromonitoring with near-infrared spectroscopy (NIRS) in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis

Cerebral desaturation events and impaired autoregulation detected by NIRS are consistently associated with poor outcomes and mortality in aSAH. However, NIRS alone provides only moderate diagnostic accuracy for DCI, with a considerable risk of false positives. The evidence is weakened by methodological limitations, heterogeneous thresholds, and the absence of a universally accepted reference standard for DCI diagnosis. Importantly, no interventional data are available to demonstrate an effect on patient outcomes. While incorporation into multimodal neuromonitoring strategies appears promising, robust prospective trials are needed before NIRS can be reliably adopted in routine clinical practice.