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J Neurol Surg B Skull Base
DOI: 10.1055/a-2436-8355
Original Article

Single Institution Experience with Lumbar Drainage and Subarachnoid Hemorrhage

William S. Coggins
1   Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Lauren E. Banko
2   School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Purav Chokhani
2   School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Elise G. Rushing
2   School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Julie Necarsulmer
3   School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
,
Deanna Sasaki-Adams
1   Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
› Author Affiliations Funding Research reported in this publication was supported by the UAMS Translational Research Institute (TRI) and the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers UL1 TR003107, KL2 TR003108, and TL1 TR003109. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Introduction In our article, we evaluate the effect of lumbar drainage on delayed cerebral ischemia and requirements for permanent cerebrospinal fluid diversion in patients with aneurysmal subarachnoid hemorrhage.

Methods We performed a retrospective cohort study from 2014 to 2023 at the University of Arkansas for Medical Sciences (UAMS) examining factors associated with patients (n = 150) who had aneurysmal subarachnoid hemorrhage and a lumbar drain placed. The main outcomes examined were incidence of delayed cerebral ischemia, need for permanent cerebrospinal fluid diversion, and neurologic outcomes at discharge that were compared to currently published standards.

Results We failed to appreciate a reduced occurrence of delayed cerebral ischemia (37.3% with the current literature supporting rates of 20–30%); however, we did find a low rate of requiring permanent cerebrospinal fluid diversion (12% compared to 10–20% in the current literature) with overall good neurologic outcomes at discharge (∼69% of patients had a Glasgow Outcome Scale [GOS] of 4–5 at discharge). Patients with GOS ≥ 4 at discharge were noted to be more likely to have more days or lumbar drainage and less likely to be older than 65 years, have had an external ventricular drain placed, and have experienced delayed cerebral ischemia.

Conclusion Lumbar drainage is a potentially useful adjunct in the management of secondary neurologic injury in subarachnoid hemorrhage.

Keywords

lumbar drain - subarachnoid hemorrhage - vasospasm - delayed cerebral ischemia - aneurysm

Previous Presentation

Poster Presentation at the 2024 North American Skull Base Society (NASBS) Annual Meeting.


Author's Contribution

Study conception, design, and search strategy were developed by W.S.C. and D.S.A. Data extraction was done by W.S.C., P.C., L.E.B., and E.G.R. Data analysis, interpretation, and manuscript production were done by all the authors. All the authors had full access to data included in this manuscript and approved its submission.




Publication History

Received: 10 April 2024

Accepted: 06 October 2024

Accepted Manuscript online:
08 October 2024

Article published online:
30 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Etminan N, Chang HS, Hackenberg K. et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 2019; 76 (05) 588-597
    CrossrefPubMedGoogle Scholar
  • 2 Hoh BL, Ko NU, Amin-Hanjani S. et al. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2023; 54 (07) e314-e370
    CrossrefPubMedGoogle Scholar
  • 3 Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013; 35 (02) 93-112
    CrossrefPubMedGoogle Scholar
  • 4 Frontera JA, Fernandez A, Schmidt JM. et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?. Stroke 2009; 40 (06) 1963-1968
    CrossrefPubMedGoogle Scholar
  • 5 Chou SHY. Subarachnoid hemorrhage. Continuum (Minneap Minn) 2021; 27 (05) 1201-1245
    CrossrefPubMedGoogle Scholar
  • 6 Macdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol 2014; 10 (01) 44-58
    CrossrefPubMedGoogle Scholar
  • 7 Hulou MM, Essibayi MA, Benet A, Lawton MT. Lumbar drainage after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. World Neurosurg 2022; 166: 261-267.e9
    CrossrefPubMedGoogle Scholar
  • 8 Klimo Jr P, Kestle JRW, MacDonald JD, Schmidt RH. Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg 2004; 100 (02) 215-224
    CrossrefPubMedGoogle Scholar
  • 9 Wolf S, Mielke D, Barner C. et al; EARLYDRAIN Study Group. Effectiveness of lumbar cerebrospinal fluid drain among patients with aneurysmal subarachnoid hemorrhage: a randomized clinical trial. JAMA Neurol 2023; 80 (08) 833-842
    CrossrefPubMedGoogle Scholar
  • 10 Al-Tamimi YZ, Bhargava D, Feltbower RG. et al. Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial (LUMAS). Stroke 2012; 43 (03) 677-682
    CrossrefPubMedGoogle Scholar
  • 11 Lai L, Morgan MK. Predictors of in-hospital shunt-dependent hydrocephalus following rupture of cerebral aneurysms. J Clin Neurosci 2013; 20 (08) 1134-1138
    CrossrefPubMedGoogle Scholar
  • 12 Hao X, Wei D. The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Medicine (Baltimore) 2019; 98 (27) e15970
    CrossrefPubMedGoogle Scholar
  • 13 Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery 2005; 56 (04) 633-654 , discussion 633–654
    CrossrefPubMedGoogle Scholar
  • 14 Frontera JA, Claassen J, Schmidt JM. et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59 (01) 21-27 , discussion 21–27
    CrossrefPubMedGoogle Scholar
  • 15 Pavelka M, Necarsulmer J, Ho J, Sasaki-Adams D. Vasospasm risk following aneurysmal subarachnoid hemorrhage in older adults. J Neurosurg 2023; 139 (05) 1302-1310
    CrossrefPubMedGoogle Scholar
  • 16 Di Russo P, Di Carlo DT, Lutenberg A, Morganti R, Evins AI, Perrini P. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg Sci 2020; 64 (02) 181-189
    CrossrefPubMedGoogle Scholar
  • 17 Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52 (04) 763-769 , discussion 769–771
    CrossrefPubMedGoogle Scholar
  • 18 Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009; 8 (07) 635-642
    CrossrefPubMedGoogle Scholar
  • 19 Catapano JS, Srinivasan VM, Labib MA. et al. The times they are a-changin': increasing complexity of aneurysmal subarachnoid hemorrhages in patients treated from 2004 to 2018. World Neurosurg 2022; 161: e168-e173
    CrossrefPubMedGoogle Scholar