Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage

Abstract

Background The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications. Objective A relation between the presence of an external CSF drain and complication risk is investigated. Methods A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications Results One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6–5.3% p = 0.01). Conclusion Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.

A predictive model for secondary central nervous system infection after craniotomy based on machine learning

“…Arts et al [20] believed that the occurrence of CNSIs was closely related to the duration of drainage tube indwelling, which was consistent with the results of this study.Long-term lumbar drainage is not only prone to the risk of drainage tube blockage and re ux, but also prone to colonization of external pathogens on the drainage tube, thereby increasing the possibility of retrograde infection.Drainage tubes are usually placed during neurosurgery, which mainly include lumbar cidal drainage tubes, ventricular drainage tubes, epidural drainage tubes, subdural drainage tubes and subcutaneous drainage tubes according to different purposes. Lin et al [21] considered that indwelling lumbar drainage tube was an independent risk factor for CNSIs.…”

Implementation of an Automated Cerebrospinal Fluid Drainage System for Early Mobilization in Neurosurgical Patients

“…While shunt dependency in this study seemed slightly higher in comparison to our earlier series regarding complications in patients treated with a conventional EVD or ELD system (22% in this study versus 15%) [ 11 ], future studies should compare patients that receive automated CSF drainage and drainage with a conventional system. The sample size of the present study is small; however, the presented results are beneficial for other neurosurgical departments planning to implement the LiquoGuard ® 7 in their clinical practise.…”

“…Complications were defined according to our earlier study regarding complications of external CSF drainage in aneurysmal subarachnoid haemorrhage (aSAH) [ 11 ], and were divided into direct and indirect complications. Direct complications were defined as complications with a direct relation to the external CSF drain (i.e., drain dislodgement, drain occlusion and meningitis).…”

Role of Ommaya Reservoir Placement in Hydrocephalus Management following Aneurysmal Subarachnoid Hemorrhage, an Initial Experience

“…This requirement was least in patients in whom lamina terminalis and fenestration of Liliquist membrane was done simultaneously (p ¼ 0.002). (►Table 3) Supplementation with Ommaya reservoir placement after removal of EVD was more common in patients in whom no cisternostomy was performed as observed in patients who underwent endovascular coiling. (►Table 4)…”

“…Replacement of EVD by Ommaya reservoir has been found to reduce chances of infection in different studies. 3,4 Some studies have reported reduced shunt dependency in hydro-cephalus following SAH when CSF is drained intermittently and gradually when compared with continuous drainage and fast weaning. 5 Few studies suggested a reduction in the rate of complications associated with intermittent EVD drainage and decreased number of ventriculoperitoneal shunts required in it.…”