Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage

Acta Neurochir (Wien). 2021 Apr;163(4):1143-1151. doi: 10.1007/s00701-020-04681-3. Epub 2021 Jan 2.


Background: The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications.

Objective: A relation between the presence of an external CSF drain and complication risk is investigated.

Methods: A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications RESULTS: One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6-5.3% p = 0.01).

Conclusion: Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.

Keywords: Complications; External cerebrospinal fluid drain; Hydrocephalus; Subarachnoid haemorrhage.

MeSH terms

  • Adult
  • Aged
  • Cerebrospinal Fluid Leak / epidemiology*
  • Cerebrospinal Fluid Leak / etiology
  • Cerebrospinal Fluid Shunts / adverse effects*
  • Drainage / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Subarachnoid Hemorrhage / surgery*