gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Protocol for gradual weaning from external ventricular drainage with repetitive lumbar punctures in patients with posthemorrhagic hydrocephalus from aneurysmal subarachnoid haemorrhage – a single-centre study

Protokoll zur schrittweisen Entwöhnung von der externen ventrikulären Drainage mit wiederholten Lumbalpunktionen bei Patienten mit posthämorrhagischem Hydrozephalus nach aneurysmatischer Subarachnoidalblutung – eine monozentrische Studie

Meeting Abstract

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  • Andrea Cattaneo - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • presenting/speaker Caroline Geske - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Florian Semmler - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Alexandra Beez - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Judith Weiland - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Kevin Lamllari - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Vera Dufner - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Christian Stetter - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ekkehard Kunze - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Christoph Wipplinger - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV201

doi: 10.3205/22dgnc195, urn:nbn:de:0183-22dgnc1954

Veröffentlicht: 25. Mai 2022

© 2022 Cattaneo et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Chronic posthemorrhagic hydrocephalus is a common condition in patients with saneurysmal subarachnoid hemorrhage (aSAH). Treatment with external ventricular drainage (EVD) is a standard life-saving treatment in the acute phase. There are currently no standards for weaning from EVD in patients with aSAH. Approaches differ from closing the EVD at once to a gradual weaning. In this study, we aim to evaluate and review the outcome of 467 patients with aneurysmal SAH who were gradually weaned with repetitive lumbar punctures (LP) or lumbar drain (LD) from their EVD and discuss the benefits and disadvantages of the presented approach.

Methods: From January 2012 to October 2021, 467 patients with aSAH were retrospectively included in our study. In our cohort, 274 patients received one EVD, 17 received two EVDs. Patient demographics, clinical presentations, SAH etiologies and grades, clamp data, hospital lengths of stay, number of days with EVD, ventriculoperitoneal shunt (VP-shunt) incidence and functional outcomes were recorded. Our protocol includes gradual weaning of patients beginning on day 10 from bleeding. The patient's EVD is gradually raised approximately 2 centimeters per day, and patients undergo a daily LP with the release of between 10 and 40 ml of CSF per puncture depending on the patient. Weaning lasts 4-6 days. In patients with CSF flow greater than 240 mL per day from the EVD were inserted a LD.

Results: The mean age of patients was 56 years (range 20-90 years), and the female-to-male ratio was 1/1.9. The majority of 256 patients (57%) had a Hunt and Hass grade III-V on admission. Of the 467 patients treated, a total of 291 patients (62%) received an EVD within the first 48 hours. Of all patients with an EVD, 111 (38%) received daily LP as part of the weaning process and 64 (23%) received a LD. Overall, 101 patients required a VP-shunt (22%). Patients undergoing daily LP or LD placement as part of the gradual weaning had a reduced risk of undergoing a VP-shunt (LP: [OR] 0,537, 95% CI 0,423-0,681, p < 0.001, LD: [OR] 0,423, 95% CI 0,324-0,551, p < 0.001).

Conclusion: Our results indicate that a gradual weaning with repetitive LP or LD placement can reduce the rate of impalntation of VP-shunt in patient with Chronic posthemorrhagic hydrocephalus after aSAH. Future research including greater sample sizes and prospective studies will be necessary to further investigate the relationship.