gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The effect of head-motion and lumboventricular lavage after severe subarachnoid haemorrhage: Results of a single centre prospective phase 1 trial

Der Effekt einer kombinierten Therapie mittels moderater Kopfrotation und forcierter zisternaler Lavage bei Patienten nach schwerer Subarachnoidalblutung: Resultate einer monozentrischen Phase-1-Studie

Meeting Abstract

  • corresponding author D. Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • J. Liersch - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • M. Yong - Institut für Medizinische Informatik, Heinrich-Heine-Universität, Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.05.09

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Hänggi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Recent publications suggested that a combination of head-shaking and cisternal irrigation might reduce cerebral vasospasm after subarachnoid hemorrhage (SAH). The current clinical prospective non-randomised phase 1 study was initiated in order to analyse the effect of enhanced wash-out by lumboventricular irrigation in combination with head-motion on clot clearance rate and development of vasospasm.

Methods: Twenty patients with aneurysmal subarachnoid haemorrhage WFNS grade 2 to 5 (GCS 13-3) and Fisher grade 3 or 4 were included in this study, approved by the local ethics committee. Following insertion of a ventricular drain, securing the aneurysm and insertion of two lumbar catheters, lumboventricular irrigation with 500ml/d Ringer solution was performed for five days. Intrathecal pressure was monitored by the second lumbar catheter. In addition, moderate head-rotation in a kinetic system was applied. Vasospasm was identified clinically witha focus on delayed neurological deficits (DIND's), daily transcranial Doppler (TCD), computerised tomography (CT) and cerebral angiography (DSA). Clot clearance rate was monitored by daily CT. The data were compared with a matched control group of twenty patients and analysed statistically.

Results: There was no procedure related complication. Fewer DIND’s occurred in the study group (n=1) compared with the control group (n=4). The pooled TCD flow velocities over a period of 14 days showed lower mean values in the study group compared to the control group (p=0.0002). Vasospasm-related infarction on CT was seen in two patients of the study group compared to six patients of the control group. Clot clearance in the study group was significantly accelerated (p=0.033). Evident vasospasm on DSA appeared more frequently and more severely in the control group. A clinical advantage of the study group was apparent at 3 and 6 months after therapy.

Conclusions: Lumboventricular lavage in combination with a head-motion device can accelerate clot lysis and reduce cerebral vasospasm in patients after severe aneurysmal SAH.