The Effectiveness of Lumbar Cerebrospinal Fluid Drainage to Reduce the Cerebral Vasospasm after Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage

Abstract

ObjectiveRemoval of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH).MethodsBetween July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality.ResultsClinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups.ConclusionLD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.

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

“…15,16 Aneurysms located in the basal cisterns, anterior communicating aneurysm, posterior circulation aneurysm, severity of aSAH, higher Fischer grade, use of EVD and non-opening of lamina terminalis are some of the other factors leading to DH in aSAH cases . [9][10][11] Decompressive craniectomy in association with low GCS, CSF infection, higher Fischer grade, advanced age and time of cranioplasty is related with increased chances of DH. The cause of DH may be secondary to CSF fl ow blockage around the convexity.…”

“…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.…”

“…[1][2][3][4] Increasing age, intraventricular hemorrhage, decompressive craniectomy, Fischer grade and aneurysms located in the basal cisterns are factors leading to DH. [4][5][6][7][8][9][10][11] Management of DH is either by inserting external drains or Ventriculo-peritoneal (VP) shunt. [6][7][8] Lumbar drain (LD) is one of the simplest, fastest, eff ective, economical methods that removes the blood and helps in the circulation of cerebrospinal fl uid to reduce hydrocephalus.…”

Trehalose decreases blood clotting in the cerebral space after experimental subarachnoid hemorrhage

“…Many clinical and experimental studies have reported that the volume and duration of subarachnoid blood clotting are directly associated with the development and severity of cerebral vasospasm [8,28]. Indeed, the removal of blood clots through irrigation of the subarachnoid space reportedly reduced the risk of cerebral vasospasm [11,14,21]. In addition, as causes of cerebral vasospasm are multifactorial, its preventive treatment would require a combination of approaches, including anti-oxidant and anti-inflammatory reagents, or a reagent with pleiotropic effects.…”

Comparison of nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage

“…These patients also present with disorders of consciousness, facial paralysis, and swallowing disturbance, which are all associated with an increased incidence of pneumonia. Furthermore, 50% of patients with an intracerebral hemorrhage also have respiratory infections [1,2].…”