Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage

Maeda, Yuichi; Shirao, Satoshi; Yanagawa, Hiroshi; Ishihara, Hideyuki; Shinoyama, Mizuya; Oka, Fumiaki; Sadahiro, Hirokazu; Ueda, Katsuhiko; Sano, Yuichi; Kudomi, Shohei; Hayashi, Yukari; Shigeeda, Tomoko; Nakano, Kaori; Koizumi, Hiroyasu; Fujii, Masami; Nomura, Sadahiro; Suzuki, Michiyasu

doi:10.1016/j.clineuro.2012.10.001

Cited by 41 publications

(21 citation statements)

References 27 publications

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“…4), which allows more rapid removal of the tracer. While the clinical impact of greater blood clearance on SAH outcomes has not been proven, researchers have shown the potential that more quickly reducing the levels of blood and inflammatory cytokines in the CSF post SAH could improve outcomes [54,55] The Neurapheresis therapy flow rate applied in our study was 2.0 mL/min with a 1.8 mL/min return flow rate. A flow rate of 2.0 mL/min is not possible to apply using a lumbar drain because it would remove CSF more rapidly than it is being produced at the choroid plexus (~ 500 mL/day) [56].…”

Section: Comparison Of Neurapheresis Therapy and Lumbar Drainmentioning

confidence: 97%

In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy

Khani

Sass

Sharp

et al. 2020

Fluids Barriers CNS

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Background: Blood removal from cerebrospinal fluid (CSF) in post-subarachnoid hemorrhage patients may reduce the risk of related secondary brain injury. We formulated a computational fluid dynamics (CFD) model to investigate the impact of a dual-lumen catheter-based CSF filtration system, called Neurapheresis ™ therapy, on blood removal from CSF compared to lumbar drain. Methods:A subject-specific multiphase CFD model of CSF system-wide solute transport was constructed based on MRI measurements. The Neurapheresis catheter geometry was added to the model within the spinal subarachnoid space (SAS). Neurapheresis flow aspiration and return rate was 2.0 and 1.8 mL/min, versus 0.2 mL/min drainage for lumbar drain. Blood was modeled as a bulk fluid phase within CSF with a 10% initial tracer concentration and identical viscosity and density as CSF. Subject-specific oscillatory CSF flow was applied at the model inlet. The dura and spinal cord geometry were considered to be stationary. Spatial-temporal tracer concentration was quantified based on time-average steady-streaming velocities throughout the domain under Neurapheresis therapy and lumbar drain. To help verify CFD results, an optically clear in vitro CSF model was constructed with fluorescein used as a blood surrogate. Quantitative comparison of numerical and in vitro results was performed by linear regression of spatial-temporal tracer concentration over 24-h. Results:After 24-h, tracer concentration was reduced to 4.9% under Neurapheresis therapy compared to 6.5% under lumbar drain. Tracer clearance was most rapid between the catheter aspiration and return ports. Neurapheresis therapy was found to have a greater impact on steady-streaming compared to lumbar drain. Steady-streaming in the cranial SAS was ~ 50× smaller than in the spinal SAS for both cases. CFD results were strongly correlated with the in vitro spatial-temporal tracer concentration under Neurapheresis therapy (R 2 = 0.89 with + 2.13% and − 1.93% tracer concentration confidence interval). Conclusion:A subject-specific CFD model of CSF system-wide solute transport was used to investigate the impact of Neurapheresis therapy on tracer removal from CSF compared to lumbar drain over a 24-h period. Neurapheresis therapy was found to substantially increase tracer clearance compared to lumbar drain. The multiphase CFD results were verified by in vitro fluorescein tracer experiments. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Section: Comparison Of Neurapheresis Therapy and Lumbar Drainmentioning

confidence: 97%

In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy

Khani

Sass

Sharp

et al. 2020

Fluids Barriers CNS

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“…The incidence of VRIs has varied significantly in previous studies, but a 2002 meta-analysis showed an incidence of 8.8% per patient treated with a ventriculostomy catheter [21]. Lumbar CSF drainage has been suggested as an alternative to ventriculostomy, possibly with a lower risk of intracerebral hemorrhage, vasospasm, and faster clearance of subarachnoid blood clots [18, 24, 36]. Lumbar drainage carries the disadvantage of not allowing reliable ICP monitoring, limiting its clinical usefulness.…”

Section: Introductionmentioning

confidence: 99%

Ventriculostomy-related infections in subarachnoid hemorrhage patients—a retrospective study of incidence, etiology, and antimicrobial therapy

et al. 2016

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BackgroundThis study was performed to investigate the incidence and etiology of ventriculostomy-related infections (VRIs) in patients with subarachnoid hemorrhage (SAH) and to assess adherence to local clinical guidelines regarding empirical antimicrobial therapy and diagnostic routines.MethodsA total of 191 consecutive SAH patients treated in the neuro-intensive care unit of Uppsala University Hospital between 2010 and 2013 were included retrospectively. Information regarding cerebrospinal fluid samples, bacterial cultures, ventriculostomy treatment, patient characteristics, and antibiotic treatment were collected from electronic patient records.ResultsEleven patients developed VRI, resulting in an incidence of 5.8% per patient, 5.4% per ventriculostomy catheter, and 4.1 per 1000 catheter days. Coagulase-negative staphylococci caused nine cases of VRI and Klebsiella pneumoniae and Staphylococcus aureus caused one each. Empirical VRI therapy was initiated on 97 occasions in 81 subjects (42.4%). Out of the 11 patients with VRI, four did not receive empirical antibiotic therapy before the positive culture result. The clinical actions performed after analysis of CSF samples were in line with the action suggested by the local guidelines in 307 out of 592 cases (51.9%).ConclusionsThe incidence of VRI in our cohort was comparable to what has previously been reported. Coagulase-negative staphylococci was the most common agent. Our study demonstrates the difficulty in diagnosing VRI in SAH patients. Improved adherence to clinical guidelines could to some extent reduce the use of empirical antibiotic treatment, but better diagnostic methods and routines are needed.

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“…4), which allows more rapid removal of the tracer. While the clinical impact of greater blood clearance on SAH outcomes has not been proven, researchers have shown the potential that more quickly reducing the levels of blood and inflammatory cytokines in the CSF post SAH could improve outcomes (48,49) The Neurapheresis therapy flow rate applied in our study was 2.0 (mL/min) with a 1.8 mL/min return flow rate. A flow rate of 2.0 mL/min is not possible to apply using a lumbar drain because it would remove CSF more rapidly than it is being produced at the choroid plexus (~500 mL/day) (50).…”

Section: Comparison Of Neurapheresis Therapy and Lumbar Drainmentioning

confidence: 97%

In vitro and Numerical Simulation of Blood Removal from Cerebrospinal Fluid: Comparison of Lumbar Drain to Neurapheresis Therapy

Khani

Sass

Sharp

et al. 2020

Preprint

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Background: Blood removal from cerebrospinal fluid (CSF) in post-subarachnoid hemorrhage patients may reduce the risk of related secondary brain injury. We formulated a computational fluid dynamics (CFD) model to investigate the impact of a dual-lumen catheter-based CSF filtration system, called Neurapheresis TM therapy, on blood removal from CSF compared to lumbar drain. Methods: A subject-specific multiphase CFD model of CSF system-wide solute transport was constructed based on MRI measurements. The Neurapheresis catheter geometry was added to the model within the spinal subarachnoid space. Neurapheresis flow aspiration and return rate was 2.0 and 1.8 (mL/min), versus 0.2 (mL/min) drainage for lumbar drain. Blood was modeled as a bulk fluid phase within CSF with a 10% initial tracer concentration and identical viscosity and density as CSF. Subject-specific oscillatory CSF flow was applied at the model inlet. The dura and spinal cord geometry were considered to be stationary. Spatial-temporal tracer concentration was quantified based on time-average steady-streaming velocities throughout the domain under Neurapheresis therapy and lumbar drain. To help verify CFD results, an optically clear in vitro CSF model was constructed with fluorescein used as a blood surrogate. Quantitative comparison of numerical and in vitro results was performed by linear regression of spatial-temporal tracer concentration over 24-hours. Results: After 24-hours, tracer concentration was reduced to 4.9% under Neurapheresis therapy compared to 6.5% under lumbar drain. Tracer clearance was most rapid between the catheter aspiration and return ports. Neurapheresis therapy was found to have a greater impact on steady-streaming compared to lumbar drain. Steady-streaming in the cranial SAS was ~50X smaller than in the spinal subarachnoid space for both cases. CFD results were strongly correlated with the in vitro spatial-temporal tracer concentration under Neurapheresis therapy (R 2 =0.89 with +2.13% and -1.93% tracer concentration confidence interval). Conclusion: A subject-specific CFD model of CSF system-wide solute transport was used to investigate the impact of Neurapheresis therapy on tracer removal from CSF compared to lumbar drain over a 24-hour period. Neurapheresis therapy was found to substantially increase tracer clearance compared to lumbar drain. The multiphase CFD results were verified by in vitro fluorescein tracer experiments.

show abstract

Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage

Cited by 41 publications

References 27 publications

In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy

In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy

Ventriculostomy-related infections in subarachnoid hemorrhage patients—a retrospective study of incidence, etiology, and antimicrobial therapy

In vitro and Numerical Simulation of Blood Removal from Cerebrospinal Fluid: Comparison of Lumbar Drain to Neurapheresis Therapy

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