The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage

Kasuya, Hidetoshi; Shimizu, Takashi; Kagawa, Mizuo

doi:10.1097/00006123-199101000-00009

Cited by 37 publications

(27 citation statements)

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“…They included higher Fisher grade,[51011192125] higher Hunt and Hess,[23510–122023–25] increased bicaudate diameter or index,[2121926] presence of acute HCP,[3101117212327] intraventricular hemorrhage,[51012181923] cisternal hemorrhage,[121824] posterior circulation location of the ruptured aneurysm,[2312171821232427] female sex,[232324] advanced age,[31011172427] development of nosocomial meningitis,[101923] admission glucose of greater than or equal to 126 mg/dL,[19] ventilation on admission[17] and continuous drainage. [8] Different studies came up with different correlations, without a consistent message and therefore with limited practical consequences. We believe that variability among treatment practices at different institutions was an important and underestimated factor precluding widespread applicability of conclusions from past research.…”

Section: Discussionmentioning

confidence: 99%

Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: Influence of physician practice style

Esposito

Goldenberg²,

Frank³

et al. 2011

Surg Neurol Int

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Background:Acute hydrocephalus (HCP) after aneurysmal subarachnoid hemorrhage (SAH) often persists. Our previous study described factors that singly and combined in a formula correlate with permanent CSF diversion. We now aimed to determine whether the same parameters are applicable at an institution with different HCP management practice.Methods:We reviewed records of 181 consecutive patients who presented with SAH and received an external ventricular drain (EVD) for acute HCP. After exclusion and inclusion criteria were met, 71 patients were analyzed. Data included admission Fisher and Hunt and Hess grades, aneurysm location, treatment modality, ventricle size, CSF cell counts and protein levels, length of stay (LOS) in the hospital, and the presence of craniectomy. Outcome measures were: (1) initial EVD challenge outcome; (2) shunting within 3 months; and (3) LOS.Results:Shunting correlated with Hunt and Hess grade, CSF protein, and the presence of craniectomy. The formula derived in our previous study demonstrated a weaker correlation with initial EVD challenge failure. Several parameters that correlated with shunting in the previous study were instead associated with LOS in this study.Conclusions:The decision to shunt depends on management choices in the context of a disease process that may improve over time. Based on the treatment strategy, the shunting rate may be lowered but LOS increased. Markers of disease severity in patients with HCP after SAH correlate with both shunt placement and LOS. This is the first study to directly evaluate the effect of different practice styles on the shunting rate. Differences in HCP management practices should inform the design of prospective studies.

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Section: Discussionmentioning

confidence: 99%

Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: Influence of physician practice style

Esposito

Goldenberg²,

Frank³

et al. 2011

Surg Neurol Int

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“…Chronic hydrocephalus after occlusion of ruptured aneurysmal subarachnoid hemorrhage (SAH) has been reported to range from 6 to 67% 16). The location of the aneurysm, initial mental status, and presence of initial intraventricular hemorrhage (IVH) are risk factors for development of chronic hydrocephalus 11)19)21)22)26).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients

Bae

Choi

et al. 2014

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe objective of this study was to compare the incidence of ventricular shunt placement for shunt-dependent hydrocephalus (SDHC) after clipping versus coiling of ruptured aneurysms.Materials and MethodsA retrospective review was conducted in 215 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping or endovascular coiling during the period from May 2008 to December 2011. Relevant clinical and radiographic data were analyzed with regard to the incidence of hydrocephalus and ventriculo-peritoneal shunt (VPS). Patients treated with clipping were assigned to Group A, while those treated with coiling were assigned to Group B.ResultsOf 215 patients (157 clipping, 58 coiling), no significant difference in the incidence of final VPS was observed between treatment modalities (15.3% vs. 10.3%) (p = 0.35). Independent risk factors for VPS for treatment of chronic hydrocephalus were as follows: (1) older than 65 years, (2) poorer Hunt-Hess grade IV and V, (3) Fisher grade III and IV, and (4) particularly initial presence of an intraventricular hemorrhage.ConclusionIn this study comparing two modalities for treatment of aneurysm, there was no difference in the incidence of chronic hydrocephalus requiring VPS. A significantly higher rate of shunt dependency was observed for age older than 65 years, poor initial neurological status, and thick SAH with presence of initial intraventricular hemorrhage. By understanding these factors related to development of SDHC and results, it is expected that management of aneurysmal SAH will result in a better prognosis.

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“…The advantages of LD in these DH cases have been well studied in literature. 2,6,[9][10][11]15,17,[24][25][26][27] In aSAH as shown by the LUMAS study in 2012 there is a reduction of prevalence of delayed ischemic neurological defi cit and improves early clinical outcome. 28 LD has also been shown to be benefi cial in post aneurysm coil embolization associated DH.…”

Section: Management Of Dhmentioning

confidence: 99%

Outcome of Lumbar Drain in Delayed Communicating Hydrocephalus Secondary to Traumatic and Aneurysmal Subarachnoid Hemorrhage

Roka¹

2020

Nep J Neurosci

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Introduction: Delayed hydrocephalus is one of the common complications in traumatic subarachnoid hemorrhage and post aneurysmal subarachnoid hemorrhage. This study aims to study the role of lumbar drain in its management. Methods: This is a retrospective study of cases of delayed hydrocephalus which were managed with lumbar drain between March 2009 to February 2019. Computed tomogram or Magnetic Resonance Imaging was used in the diagnosis of delayed hydrocephalus and lumbar drain was inserted. A repeat Computed tomogram scan was performed, and the absence of delayed hydrocephalus was the indication for removal. Results: A total of 40 cases of delayed hydrocephalus were managed with lumbar drain during the study period. Traumatic subarachnoid hemorrhage was the cause of delayed hydrocephalus in 16 cases and the remaining 24 cases were due to post aneurysmal subarachnoid hemorrhage. The most common Fischer grade was III in aneurysm and II in trauma. Delayed hydrocephalus occurred within two to four weeks in aneurysm cases and after four weeks in traumatic cases. All aneurysm was managed with clipping whereas craniotomy or decompressive craniectomy was done in traumatic cases. 92.5% of cases improved after lumbar drainage of the hydrocephalus. Conclusion: This study reports the use of lumbar drain to treat delayed post subarachnoid hemorrhage hydrocephalus in a clinically-cost-effective way with minimal complications. Randomized studies to compare methods to treat delayed hydrocephalus will overcome the limitations of this study. Till then lumbar drain remains a safe alternative in communicating delayed hydrocephalus secondary to subarachnoid hemorrhage.

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The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage

Cited by 37 publications

References 0 publications

Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: Influence of physician practice style

Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: Influence of physician practice style

Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients

Outcome of Lumbar Drain in Delayed Communicating Hydrocephalus Secondary to Traumatic and Aneurysmal Subarachnoid Hemorrhage

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