J Korean Neurosurg Soc.  2015 Mar;57(3):167-173. 10.3340/jkns.2015.57.3.167.

The Effectiveness of Lumbar Cerebrospinal Fluid Drainage to Reduce the Cerebral Vasospasm after Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage

• Park S
• Yang N
• Seo E

• KMID: 2191216
• DOI: http://doi.org/10.3340/jkns.2015.57.3.167

Abstract

OBJECTIVE
Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH).
METHODS
Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality.
RESULTS
Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups.
CONCLUSION
LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.

Keyword

Aneurysm; Subarachnoid hemorrhage; Lumbar drainage; Cerebral vasospasm; Surgical clipping

MeSH Terms

Aneurysm
Angioplasty
Cerebral Infarction
Cerebrospinal Fluid*
Drainage*
Follow-Up Studies
Glasgow Outcome Scale
Humans
Mortality
Subarachnoid Hemorrhage*
Subarachnoid Space
Surgical Instruments*
Vasospasm, Intracranial*

Figure

• 

  Fig. 1 Non-contrast axial CT scan showing the modified Fisher grade 3+4. A : CT scan shows dense subarachnoid hemorrhage in basal cistern and small amount of intraventricular hemorrhage in both lateral ventricle. B : Non-contrast CT scan demonstrates thick subarachnoid hemorrhage in basal cistern and small amount of intraventricular hemorrhage in 3rd ventricle and lateral ventricle.

• 

  Fig. 2 Photograph shows closed lumbar drainage kit composed infusion pump and closed drainage bag. We performed lumbar CSF drainage slowly and continuously with drainage rate 5 to 10 mL/hour. CSF : cerebrospinal fluid.

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