Duration of Cerebrospinal Fluid Drainage in Patients With Aneurysmal Subarachnoid Hemorrhage for Prevention of Symptomatic Vasospasm and Late Hydrocephalus

Abstract

The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p ＝ 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p ＝ 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.

Lumbar drainage for subarachnoid hemorrhage: technical considerations and safety analysis

“…The closed drainage system drains by gravity with the collection chamber adjusted to regulate flow have been made by attempting to clear the clots. Several groups from Japan have advocated cisternal drainage and irrigation of CSF after SAH to lessen the risk and severity of vasospasm [1,3]. Others have championed the application of intra-cisternal fibrinolytic agents to break down the clots and promote early drainage of the blood away from the arteries at the base of the brain [1,3,10].…”

“…Several groups from Japan have advocated cisternal drainage and irrigation of CSF after SAH to lessen the risk and severity of vasospasm [1,3]. Others have championed the application of intra-cisternal fibrinolytic agents to break down the clots and promote early drainage of the blood away from the arteries at the base of the brain [1,3,10]. While there are no randomized-controlled trials indicating that increased and early clearance of blood from the basal cisterns is of benefit, it is hypothesized by some investigators that this should be so.…”

“…Longer-term drainage may also improve outcome by allowing for improved cerebral perfusion pressure in patients suffering from cerebral vasospasm. The removal of some of the blood from the CSF pathways may additionally decrease the risk of developing cerebral vasospasm [1][2][3].…”

Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: a Pilot Study

“…However, because the time period during which erythrocytes break down and blood disappears from the cerebrospinal fluid (CSF) closely mirrors the onset and resolution of clinical vasospasm, it is widely accepted that blood products, such as oxyhemoglobin, act as spasmogens and contribute to vasospasm [4][5][6]. A high correlation also exists between the severity of the vasospasm and the volume of subarachnoid blood in the cisterns and ventricular system [6,7]. It has been postulated that decreasing the burden of subarachnoid blood may reduce the likelihood of developing vasospasm.…”

“…Intraventricular catheters are often inserted in patients with moderate to severe degrees of SAH in order to monitor ICP, allow for CSF diversion and treat acute hydrocephalus [6]. Duke University currently supports two different methods of CSF drainage and ICP monitoring for patients diagnosed with SAH.…”