Safety and feasibility of lumbar drainage in the management of poor grade aneurysmal subarachnoid hemorrhage

J Clin Neurosci. 2019 Jun;64:64-70. doi: 10.1016/j.jocn.2019.04.010. Epub 2019 Apr 22.

Abstract

The use of lumbar drain (LD) in the aneurysmal subarachnoid hemorrhage (aSAH) has been described to reduce cerebral vasospasm and delayed cerebral ischemia (DCI), with a lack of studies referring to high grade population. The purpose of our study is to assess safety and feasibility of LD in the poor grade aSAH population subjected to endovascular aneurysm occlusion. Twenty-four consecutive poor grade aSAH patients, defined as grade IV and V according to World Federation of Neurological Surgeons (WFNS) classification, subjected to endovascular aneurysm occlusion, were retrospectively reviewed. Details of CSF drainage via LD and related complications were analyzed. Ventriculo-lumbar pressure gradient (VLPG) lower than 6 mmHg was considered in order to start LD use. Good outcome was defined as modified Rankin Scale (mRS) 0-2. LD was started within 72 h since aSAH in 17 cases (70.8%), and in 7 cases (29.2%) it was delayed due to contraindications. The mean LD length was of 13.8 days. The median VLPG during drainage was 2 mmHg (IQR: 0-4). No cases of brain or spinal hemorrhage, permanent neurological worsening due to brain herniation were noted. Three cases (12.5%) of CSF infection and a related death (4.2%) were reported. The use of LD, in association with external ventricular drain (EVD), seems to be safe and feasible in the poor grade aSAH population. VLPG monitoring seems to play a key role in avoiding potentially severe complications.

Keywords: Aneurysm; Lumbar drain; Poor grade; Subarachnoid hemorrhage.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Cerebrospinal Fluid*
  • Drainage / methods
  • Female
  • Humans
  • Intracranial Aneurysm / complications*
  • Middle Aged
  • Retrospective Studies
  • Subarachnoid Hemorrhage / cerebrospinal fluid
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / therapy*