Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury

Manet, Romain; Payen, Jean‐François; Guerin, Romain; Martinez, Orianne; Hautefeuille, Serge; Francony, Gilles; Gergelé, Laurent

doi:10.1007/s00701-017-3290-1

Cited by 21 publications

(38 citation statements)

References 26 publications

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“…This is acute hydrocephalus and frequently requires an external ventricular drain (EVD). An alternative form of acute hydrocephalus, without ventricular enlargement, is 'external hydrocephalus' due to impairment of CSF absorption in Pacchionian granulations [1,2] when only the cranial subarachnoid space is enlarged. Different trials, especially recent decompressive craniectomy trials, have reported variable incidences of hydrocephalus post severe TBI, and the rate of reporting hydrocephalus as a complication of TBI varies between 0.7 and 50% [7][8][9][10][11].…”

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confidence: 99%

“…In the late phase after TBI, patients can present with symptoms or signs similar to idiopathic normal pressure hydrocephalus (iNPH) resulting from impairment of CSF circulation in the subarachnoid space in response to the post-traumatic inflammatory process. The ventricles are enlarged but ICP remains normal [1][2][3]12]. Post-acute PTH could inhibit rehabilitation and be the main contributing factor to poor long-term outcome after TBI [13,14].…”

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Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly

Lalou

Levrini

Czosnyka

et al. 2020

Fluids Barriers CNS

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Background: Post-traumatic hydrocephalus (PTH) is potentially under-diagnosed and under-treated, generating the need for a more efficient diagnostic tool. We aim to report CSF dynamics of patients with post-traumatic ventriculomegaly. Materials and methods: We retrospectively analysed post-traumatic brain injury (TBI) patients with ventriculomegaly who had undergone a CSF infusion test. We calculated the resistance to CSF outflow (Rout), AMP (pulse amplitude of intracranial pressure, ICP), dAMP (AMPplateau-AMPbaseline) and compensatory reserve index correlation coefficient between ICP and AMP (RAP). To avoid confounding factors, included patients had to be non-decompressed or with cranioplasty > 1 month previously and Rout > 6 mmHg/min/ml. Compliance was assessed using the elasticity coefficient. We also compared infusion-tested TBI patients selected for shunting versus those not selected for shunting (consultant decision based on clinical and radiological assessment and the infusion results). Finally, we used data from a group of shunted idiopathic Normal Pressure Hydrocephalus (iNPH) patients for comparison. Results: Group A consisted of 36 patients with post-traumatic ventriculomegaly and Group B of 45 iNPH shunt responders. AMP and dAMP were significantly lower in Group A than B (0.55 ± 0.39 vs 1.02 ± 0.72; p < 0.01 and 1.58 ± 1.21 vs 2.76 ± 1.5; p < 0.01. RAP baseline was not significantly different between the two. Elasticity was higher than the normal limit in all groups (average 0.18 1/ml). Significantly higher Rout was present in those with probable PTH selected for shunting compared with unshunted. Mild/moderate hydrocephalus, ex-vacuo ventriculomegaly/ encephalomalacia were inconsistently reported in PTH patients. Conclusions: Rout and AMP were significantly lower in PTH compared to iNPH and did not always reflect the degree of hydrocephalus or atrophy reported on CT/MRI. Compliance appears reduced in PTH.

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Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly

Lalou

Levrini

Czosnyka

et al. 2020

Fluids Barriers CNS

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“…El diagnóstico se basa en los siguientes elementos: alto índice de sospecha cuando se presenta una patología como las citadas; presencia de HIC con cisternas presentes y conservación del buffer espacial, o los métodos no invasivos (medida ultrasonográfica de la vaina del nervio óptico o el Doppler transcraneal) detectan hallazgos sugestivos de HIC. En todos estos casos el DLE es de elección para el control de la HIC y debe ser considerado la primera medida a realizar (34)(35)(36)(37)(38) .…”

Section: Tratamiento De La Hic Con Cisternas Basales Presentesunclassified

“…Algunos autores, como Manet y colaboradores, agregan a estas condiciones el desarrollo gradual de colecciones subaracnoideas o subdurales localizadas en la cisura de Silvio o interhemisférica, o en los surcos de la convexidad. Esto se basa en el mecanismo fisiopatológico planteado por estos autores como causa de esta situación y que consiste en la denominada hidrocefalia externa (34)(35)(36) .…”

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Drenaje lumbar externo en la unidad de cuidados intensivos

Grille

Salle

Biestro

2020

RMU

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El drenaje lumbar externo es un procedimiento invasivo de extracción de líquido cefalorraquídeo del espacio espinal cuyo uso se ha incrementado en los últimos años en el contexto de la medicina neurocrítica. Si bien no es recomendado por las guías o consensos internacionales, tiene un lugar en el manejo de algunas situaciones clínicas específicas vinculadas a diferentes tipos de neuroinjuria grave. Se realiza una revisión no sistemática de la literatura, a lo que se suma la experiencia de los autores. Se plantean las principales indicaciones actuales, se detallan las características de su manejo en los distintos escenarios clínicos y se señalan las contraindicaciones y complicaciones del procedimiento.

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“…[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. 6,12,13 LD although simple can cause complications which include infection, dislodgement, neurogenic pain, tentorial herniation, syringomyelia, headache and pneumocephalus. 2,9 This study aims to study the outcome of lumbar alone in DH and the author believes that this is the fi rst study to be reported from Nepal.…”

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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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Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury

Abstract: These findings indicate that ELD may be considered potentially effective in controlling ICP, remaining safe if a firm diagnosis of communicating external hydrocephalus has been made.

Cited by 21 publications

References 26 publications

Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly

Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly

Drenaje lumbar externo en la unidad de cuidados intensivos

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

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