The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal ubarachnoid Hemorrhage

Kwon, Ou Young; Kim, Young-Joon; Kim, Young Jin; Cho, Chun Sung; Lee, Sang Koo; Cho, Maeng Ki

doi:10.3340/jkns.2008.43.6.281

Cited by 67 publications

(34 citation statements)

References 39 publications

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“…Although lumbar drainage has previously been shown to reduce the need for permanent CSF diversion (24% with lumbar drain versus 36% without lumbar drain), 2 this reduction has not been consistently demonstrated. 12 In the current study, there was no significant difference in the need for permanent CSF diversion between the 2 groups (with a slight trend toward fewer permanent CSF diversion procedures in the lumbar drain group). 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.…”

Section: Discussionmentioning

confidence: 79%

“…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. 2,12 A lumbar drain is less invasive than other forms of CSF drainage and is a device that is regularly used for other clinical purposes. In a retrospective nonrandomized study, the prevalence of DIND was 17% in those patients with a lumbar drain in situ and 51% in those without a drain.…”

mentioning

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: 79%

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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“…Lumbar drainage (LD), a simple and less invasive bedside technique, has been increasingly used to replace EVD, thereby reducing EVD duration and avoiding EVD exchange [7][8][9]. Moreover, additional beneficial effects of LD on the development of vasospasm after SAH [10][11][12][13] and the incidence of permanent hydrocephalus after ICH with severe ventricular involvement [7][8][9] have been suggested, likely by accelerating blood removal from the subarachnoid space.…”

Section: Introductionmentioning

confidence: 98%

Lumbar Catheter for Monitoring of Intracranial Pressure in Patients with Post-Hemorrhagic Communicating Hydrocephalus

et al. 2010

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“…Preliminary data have suggested that lumbar drainage is associated with reduced incidence of vasospasm. 214,255 Serial lumbar punctures to manage acute aSAH-associated hydrocephalus have been described as safe, but this strategy has only been assessed in small retrospective series. 239,257 Chronic hydrocephalus associated with aSAH is usually treated with ventricular shunt placement.…”

Section: Management Of Hydrocephalus Associated With Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal ubarachnoid Hemorrhage

Cited by 67 publications

References 39 publications

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Lumbar Catheter for Monitoring of Intracranial Pressure in Patients with Post-Hemorrhagic Communicating Hydrocephalus

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

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