The Effect of Continuous Drainage of Cerebrospinal Fluid in Patients with Subarachnoid Hemorrhage: A Retrospective Analysis of 108 Patients

Kasuya, Hidetoshi; Shimizu, Takashi; Kagawa, Mizuo

doi:10.1227/00006123-199101000-00009

Cited by 103 publications

(56 citation statements)

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“…In contrast, cisternal CSF drainage and irrigation has been associated with a higher rate of permanent CSF diversion with the volume of drainage proportional to this rate. 10,11,23 It is unclear why lumbar drainage did not increase the occurrence of long-term hydrocephalus. Acute and chronic hydrocephalus is thought to result from tentorial/ventricular obstruction and blockage of arachnoid granulations with blood, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Al‐Tamimi

Bhargava

Feltbower

et al. 2012

Stroke

141

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Background and Purpose— A single-center prospective randomized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome. Methods— Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grades 2, 3, 4, and 3+4 were randomized to either the study group of standard therapy plus insertion of a lumbar drain or the control group of standard therapy alone. The primary outcome measure was the prevalence of delayed ischemic neurological deficit. Results— Two hundred ten patients with aneurysmal subarachnoid hemorrhage (166 female, 44 male; median age, 54 years; interquartile range, 45–62 years) were recruited into the control (n=105) and study (n=105) groups of the trial. World Federation of Neurological Surgeons grade was: 1 (n=139), 2 (n=60), and 3 (n=11); Fisher grade was: 2 (n=87), 3 (n=85), and 4 (n=38). The prevalence of delayed ischemic neurological deficit was 35.2% and 21.0% in the control and study groups, respectively ( P =0.021). The prevalence of a modified Rankin Scale score of 4, 5, or 6 at Day 10 and 6 months, respectively, was 62.5% and 18.6% in the control group and 44.8% and 19.8% in the study group ( P =0.009 and 0.83, respectively). Conclusions— Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage. Clinical Trial Registration— URL: www.clinicaltrials.gov . Unique identifier: NCT00842049.

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Section: Discussionmentioning

confidence: 99%

“…6 -9 Studies investigating cisternal drainage have reported mixed results. 6,10,11 Cisternal drains and intrathecal thrombolysis are difficult to administer and not without morbidity. There has been some evidence to suggest that drainage of cerebrospinal fluid (CSF) through the lumbar cistern may be of some benefit in reducing the prevalence of DIND.…”

mentioning

confidence: 99%

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Al‐Tamimi

Bhargava

Feltbower

et al. 2012

Stroke

141

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“…Measurement of sequential changes of oxyhemoglobin concentration showed decreases by day 5 and maintenance at a very low level with urokinase irrigation, but increases peaking on day 9 without urokinase irrigation. 13) Our previous report 9) and others 1,12,15) have indicated that duration of CSF drainage is a statistically significant predictor of late hydrocephalus after SAH. Continuous CSF drainage may promote occlusion of physiological CSF pathways.…”

Section: Discussionmentioning

confidence: 88%

“…Excessive drainage of CSF is related to a greater incidence of cerebral infarction and occurrence of late hydrocephalus. 1,12) It is possible that such cerebral infarction is causally related to the occurrence of late hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…3,16) However, increased incidence of cerebral infarction and late shunt-dependent hydrocephalus have been observed following excessive drainage of CSF. 1,9,12,15) Meningitis and intracranial hemorrhage are also possible complications of CSF drainage. 17) No data is available about the duration of CSF drainage necessary after acute surgery to prevent the occurrence of vasospasm and late hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

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

Hirashima

Kurimoto

Hayashi

et al. 2005

Neurol. Med. Chir.(Tokyo)

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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.

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Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage

Wolf,

Mielke,

Barner

et al. 2023

JAMA Neurol

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ImportanceAfter aneurysmal subarachnoid hemorrhage, the use of lumbar drains has been suggested to decrease the incidence of delayed cerebral ischemia and improve long-term outcome.ObjectiveTo determine the effectiveness of early lumbar cerebrospinal fluid drainage added to standard of care in patients after aneurysmal subarachnoid hemorrhage.Design, Setting, and ParticipantsThe EARLYDRAIN trial was a pragmatic, multicenter, parallel-group, open-label randomized clinical trial with blinded end point evaluation conducted at 19 centers in Germany, Switzerland, and Canada. The first patient entered January 31, 2011, and the last on January 24, 2016, after 307 randomizations. Follow-up was completed July 2016. Query and retrieval of data on missing items in the case report forms was completed in September 2020. A total of 20 randomizations were invalid, the main reason being lack of informed consent. No participants meeting all inclusion and exclusion criteria were excluded from the intention-to-treat analysis. Exclusion of patients was only performed in per-protocol sensitivity analysis. A total of 287 adult patients with acute aneurysmal subarachnoid hemorrhage of all clinical grades were analyzable. Aneurysm treatment with clipping or coiling was performed within 48 hours.InterventionA total of 144 patients were randomized to receive an additional lumbar drain after aneurysm treatment and 143 patients to standard of care only. Early lumbar drainage with 5 mL per hour was started within 72 hours of the subarachnoid hemorrhage.Main Outcomes and MeasuresPrimary outcome was the rate of unfavorable outcome, defined as modified Rankin Scale score of 3 to 6 (range, 0 to 6), obtained by masked assessors 6 months after hemorrhage.ResultsOf 287 included patients, 197 (68.6%) were female, and the median (IQR) age was 55 (48-63) years. Lumbar drainage started at a median (IQR) of day 2 (1-2) after aneurysmal subarachnoid hemorrhage. At 6 months, 47 patients (32.6%) in the lumbar drain group and 64 patients (44.8%) in the standard of care group had an unfavorable neurological outcome (risk ratio, 0.73; 95% CI, 0.52 to 0.98; absolute risk difference, −0.12; 95% CI, −0.23 to −0.01; P = .04). Patients treated with a lumbar drain had fewer secondary infarctions at discharge (41 patients [28.5%] vs 57 patients [39.9%]; risk ratio, 0.71; 95% CI, 0.49 to 0.99; absolute risk difference, −0.11; 95% CI, −0.22 to 0; P = .04).Conclusion and RelevanceIn this trial, prophylactic lumbar drainage after aneurysmal subarachnoid hemorrhage lessened the burden of secondary infarction and decreased the rate of unfavorable outcome at 6 months. These findings support the use of lumbar drains after aneurysmal subarachnoid hemorrhage.Trial RegistrationClinicalTrials.gov Identifier: NCT01258257

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The Effect of Continuous Drainage of Cerebrospinal Fluid in Patients with Subarachnoid Hemorrhage: A Retrospective Analysis of 108 Patients

Cited by 103 publications

References 0 publications

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

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

Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage

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