gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Therapy of malignant intracranial hypertension by lumbar cerebrospinal fluid drainage

Lumbale Liquor-Drainage zur Behandlung der therapierefraktären ICP-Erhöhung

Meeting Abstract

  • corresponding author Elke Münch - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • J. Woitzik - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • C. Thomé - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • P. Schmiedek - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • P. Vajkoczy - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.05.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0197.shtml

Veröffentlicht: 23. April 2004

© 2004 Münch et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Closed continuous lumbar drainage of crebrospinal fluid (CSF) has been used in neurosurgery for a variety of reasons. The use of lumbar drainage in uncontrollable intracranial hypertension was considered to be contraindicated because of the possibility of inducing transtentorial or tonsillar herniation. The objective of these study was to investigate the effect of continuous external lumbar CSF drainage on intracranial pressure (ICP) and to evaluate the potential side effects of these new therapeutic modality in adult patients suffering sustained therapy-resistant intracranial hypertension.

Methods

From 2/1998 to 11/2003, prospective evaluation of 68 patients (age 42±17 yrs) with therapy-resistant ICP increase following severe traumatic brain injury (TBI) (n=28) or severe subarachnoid hemorrhage (SAH) (n=40) was carried out. Patients were considered for external lumbar fluid drainage if they suffered persistent intracranial hypertension of values more than 25 mmHg for a period of more than 15 minutes and failed to respond to high intensity treatment. External lumbar drainage was not performed in patients with tight basal cisterns. After institution of the lumbar drain (silicon-catheter, Touhy type needle) aspiration of 5 to 20 ml CSF was performed and continuous CSF-drainage was maintained. ICP and CPP before and after bolus-aspiration was documented. The neurological outcome of the patients was scored according to the Glasgow Outcome Scale (GOS) at discharge.

Results

All patients showed a significant decrease of ICP from 33.4±9.8 mmHg to 13.7±5.4 mmHg and an increase of CPP from 67.3±18.8 mmHg to 85.6±13.3 mmHg. Two patients showed a unilateral dilated and fixed pupil. In patients suffering from SAH two (5%) showed a favorable outcome (GOS 4/5), 13 patients (33%) survived with a severe permanent neurological deficit (GOS 3), 5 patients (12%) remained in a persistent vegetative state (GOS 2) and 20 patients (50%) died (GOS 1). In TBI patients four (14%) showed a GOS 4/5, twelve patients (43%) presented with a GOS 3, five (18%) patients with a GOS 2 and seven patients (25%) died.

Conclusions

Controlled external lumbar drainage reduces therapy-resistant intracranial hypertension significantly. However, our results indicate that patients with TBI benefit from lumbar CSF drainage whereas in patients suffering from SAH the control of ICP doesn´t lead to an improved outcome. The hazard of transtentorial or tonsillar herniation might be limited by considering lumbar drainage only in the presence of discernible basilar cisterns.