J Cerebrovasc Endovasc Neurosurg.  2020 Jun;22(2):53-64. 10.7461/jcen.2020.22.2.53.

Risk factors of postoperative remote intracerebral hemorrhage after craniotomy for ruptured cerebral aneurysms

• Lee I
• Park CW
• You CJ
• Choi DH
• Park K
• Kim YB
• Kim WK
• Yee GT
• Kim MJ
• Kim EY

• KMID: 2503818
• DOI: http://doi.org/10.7461/jcen.2020.22.2.53

Abstract

Objective
We aimed to identify the relation between perioperative cerebrospinal fluid (CSF) drain through lumbar drainage (LD) and development of postoperative (POP) remote intracerebral hemorrhage (rICH) in craniotomy to treat ruptured intracranial aneurysms.
Methods
We retrospectively reviewed consecutive patients who underwent craniotomy for ruptured cerebral aneurysms at the authors’ institution between 1998 and 2004. We subsequently compared the incidence and characteristics of POP rICH between the patients who had a perioperative LD and those who did not. All statistical analyses were conducted using the software package SPSS 19.0 (SPSS Inc., Chicago, IL, USA). A p value of <0.05 was considered statistically significant.
Results
We enrolled 688 patients, of which 80 patients (11.6%) received perioperative LD, and 608 did not. LD and non-LD groups were comparable because although clinical characteristics of the two groups were significantly different considering history of hypertension, timing of surgery, and closed system negative pressure suction drain (SD) placement, none of these three variables was an independent risk factor associated with POP rICH in multivariate analysis. POP rICH incidence was significantly higher in the LD goup (12.5%) than non-LD group (0.8%) (p=0.000) in univariate analysis. LD placement was the only independent risk factor associated with the development of rICH in multivariate logistic regression analysis.
Conclusions
POP rICH incidence was significantly higher in patients who were managed with perioperative LD than in those who did not. LD insertion in craniotomy for ruptured intracranial aneurysm, should be closely monitored to address the occurrence of POP rICH.

Keyword

Intracranial aneurysm; Postoperative hemorrhage; Cerebrospinal fluid; Cerebrospinal fluid leak

Figure

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  Fig. 1 Here, we demonstrate and summarize potential pathogenesis and progress associated with the development of rICH and unknown, unidentified neurological conditions. The arrows and lines of dotted, and the arrow and relatively thinner line indicate low and moderate levels of possible pathogeneses, respectively. BP, blood pressure; CSF, cerebrospinal fluid; LD, lumbar drainage; SD, suction drainage. rICH, remote intracerebral hemorrhage.

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  Fig. 2 Suggested pathogenesis of postoperative (POP) remote intracerebral hemorrhage (rICH) and other feasible neurological disorders or phenomena. CSF over-loss (hypovolemia) is the initial event and/or root cause which may trigger diverse neurological phenomena or complications including POP rICH. CSF, cerebrospinal fluid.

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