gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The effect of lumbar drainage on cerebral vasospasm and infarction after subarachnoid haemorrhage

Meeting Abstract

  • K. Tizi - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • E. Güresir - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • J. Beck - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • A. Raabe - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • V. Seifert - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • H. Vatter - Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.05-07

DOI: 10.3205/09dgnc141, URN: urn:nbn:de:0183-09dgnc1417

Published: May 20, 2009

© 2009 Tizi et al.
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Outline

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Objective: Vasospasm continues to be a major source of morbidity in patients after subarachnoid haemorrhage (SAH). It was suggested that by using a lumbar drainage and increasing the clearance of blood degradation a decrease in the incidence of vasospasm would occur. Therefore we compared the rates of vasospasm in patients with and without lumbar drainage (LD).

Methods: The present prospective study covers a consecutive series of 79 patients with SAH collected between 01/2006 and 06/2008. We included patients suffering from SAH Hunt and Hess grades 1–5 and Fisher grade 3. In 39 patients LD was used. The control group consisted of 40 patients and matched to the LD group with respect to Hunt and Hess, Fisher grade, age, sex, and location of the aneurysm. In both groups external ventricular drainage (EVD) was initially placed if necessary. LD was placed 3 days after surgical or endovascular treatment of the ruptured aneurysm and ct-scan ruling out contraindications. The efficacy of LD was 5–10 ml/h. Cerebral vasospasm was detected with Digital Subtraction Angiography. For the detection of cerebral infarction MRI or CT scan was performed.

Results: The overall incidence of angiographic vasospasm was significantly lower in the LD compared to the control group (28% vs. 82%; p<0.0001, OR 12, 95% CI 4.1–35). Severe vasospasm occurred only in 13% in the treatment group, compared to 35% in patients who received no lumbar drainage. However cerebral infarction in more than one territory occurred significantly more often in patients without lumbar drainage (40% vs.15.4% p=0.02, OR 3.7, CI 1.2-10.7). Furthermore no significant difference could be found comparing the necessity for VP-shunt after 6 months (25% vs. 20%)

Conclusions: The use of a LD after aneurysmal SAH leads to a significant reduction of cerebral vasospasm. Patients in the group without LD suffered significantly more often of cerebral infarctions extending to more than one vascular territory. LD shows beneficial effects, which are useful in reducing vasospasm after SAH. It is safe and easy to perform and complications are rare.