Article
The effect of lumbar drainage on chronic hydrocephalus and shunt dependency after subarachnoid hemorrhage
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Authors
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Karima Tizi
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
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Erdem Güresir
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
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Mathias Setzer
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
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Volker Seifert
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
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Hartmut Vatter
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Subarachnoid hemorrhage (SAH) is a common cause of chronic hydrocephalus. The large amount of blood in the subarachnoid space is the triggering cause of this chronic cerebrospinal fluid (CSF) absorptional and circulatory disorder.The disturbance of CSF circulation and absorption is in the majority of cases treated by continuous external ventricular CSF drainage. It was suggested that by using a lumbar drainage and increasing the clearance of blood degradation a decrease in the incidence of shunt dependent chronic hydrocephalus would occur. A few authors also suggested that the use of LD could increase the incidence of shunt dependent chronic hydrocephalus. Therefore we compared the rates of shunt dependency after SAH in patients with and without lumbar drainage (LD).
Methods: This present prospective study covers a consecutive series of 166 patients with SAH collected between 01/2005 and 06/2008. We included patients suffering from SAH Hunt and Hess grades 1–5 and Fisher grade 3. In 41 patients LD was used. The control group consisted of 125 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. The LD was left in situ for 14 days. The follow-up time to evaluate if a chronic hydrocephalus with shunt dependency occurred was 6 months.
Results: The treatment group consisted of 41 patients, with a mean age of 50y, 29 female and 12 male patients (69,6% vs 30,4%), the control group consisted 125 patients with a mean age of 53 y, 87 female and 38 male cases (70,7% vs 29,3%).
The incidence rate of chronic hydrocephalus in the treatment group was 24,4% (10/41 cases), compared to the control group chronic hydrocephalus showed in 23,2% (27/125 cases) p=0,876.
Conclusions: The results revealed no significant association between the use of LD after SAH and a reduced incidence of chronic shunt dependent hydrocephalus.
