Continuous lumbar cistern drainage before surgical clipping for aneurysmal subarachnoid hemorrhage.

Continuous lumbar cistern drainage before surgical clipping for aneurysmal subarachnoid hemorrhage.

World Neurosurg. 2018 Jan 17;:

Authors: Xu N, Meng H, Liu T, Feng Y, Qi Y, Wang H

Abstract
BACKGROUND: Lumbar drainage (LD) is the choice for the treatment of acute hydrocephalus and increased intracranial pressure in patients with subarachnoid hemorrhage (SAH). It also reduces vasospasm risk and delayed ischemic neurological events. We evaluated the role of LD in the preoperative management of patients with aneurysmal SAH (aSAH).
PATIENTS AND METHODS: From January 2011 to January 2013, 520 patients with aSAH were subjected to clipping surgery and were prospectively enrolled in this study. Information was collected on each patient regarding neurologic function, Hunt-Hess scales, NIHSS scores, post-operative complications, and prognosis. 320 patients were grouped into preoperative lumbar drainage group (CLD group), while 200 into non-preoperative lumbar drainage (non-CLD group).
RESULTS: The rates of postoperative complications (DIND, chronic hydrocephalus) and re-bleeding, and mortality were significantly lower in CLD group than in non-CLD (DIND: 21.9 vs. 30.5%; chronic hydrocephalus: 6.7 vs. 20%; re-bleeding: 2.5 vs. 8.5%; mortality: 5 vs. 12%, respectively). However, the rate of intracranial infection was similar between two groups (p>0.05).
CONCLUSION: A careful preoperative application of continuous lumbar drainage may reduce postoperative DIND, chronic hydrocephalus, re-bleeding, and mortality in aSAH patients who received surgical clipping treatment for intracranial aneurysmal rupture.

PMID: 29355804 [PubMed - as supplied by publisher]

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