gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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The duration and rate of cerebrospinal fluid drainage during the acute phase after aneurysmal subarachnoid hemorrhage corellate with shunt dependency

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  • Turab Gasimov - Neurochirurgie UMG, Göttingen, Deutschland
  • Bogdan Iliev - Neurochirurgie UMG, Göttingen, Deutschland
  • Dorothee Mielke - Neurochirurgie UMG, Göttingen, Deutschland
  • Veit Rohde - Neurochirurgie UMG, Göttingen, Deutschland
  • Vesna Malinova - Neurochirurgie UMG, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 206

doi: 10.3205/17dgnc769, urn:nbn:de:0183-17dgnc7697

Published: June 9, 2017

© 2017 Gasimov et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Temporary cerebrospinal fluid (CSF) drainage is often required to treat acute hydrocephalus in the early phase after aneurysmal subarachnoid hemorrhage (aSAH). According to the literature, 15-20% of the patients later require a permanent CSF diversion. In experimental studies a higher production rate of CSF as a part of the pathophysiology of hydrocephalus after aSAH was postulated. Higher CSF production might contribute to higher CSF drainage volumes in the acute phase after aSAH. The aim of this study was to evaluate the CSF drainage rate and duration in the acute phase after aSAH as a predictor of shunt dependency

Methods: A patient population with aSAH admitted to our department from January 2012 to September 2016 was retrospectively analyzed for the development of shunt dependency. Additionally, we analyzed the CSF drainage rate per day and the CSF drainage duration in the acute phase after the diagnosis of aSAH (day 0-14). The correlation of the CSF drainage rate and duration with shunt dependency was assessed

Results: A total of 203 patients were enrolled in the study. The mean age of the patients was 55 years (range 23-90), 67% (136/203) were female and 33% (67/203) male. In 89% (181/203) of the patients CSF was drained (in 25% via an external ventricular drainage, 28% had a lumber drainage and 36% had both). In 24% (48/203) of the patients the insertion of ventriculoperitoneal shunt was required. The patients with shunt dependency had a significantly higher CSF drainage rate compared to the patients without shunt dependency (mean 182ml/day vs 136ml/day, linear regression p=0.003). The cut-off was 120ml/day (ROC analysis, AUC 0.67 95% CI 0.59-0.76, p=0.0002). The duration of CSF drainage was longer in the patients with shunt dependency compared to the patients without shunt dependency (mean 20 days vs 11 days, linear regression p<0.0001). The cut-off was 7 days (ROC analysis, AUC 0.80 95% CI 0.74-0.87, p<0.0001).

Conclusion: A higher CSF drainage rate and a longer CSF drainage in the acute phase after aSAH are predictors of later shunt dependency. Our results support the hypothesis of experimental studies that a higher CSF production might be a contributor to hydrocephalus and shunt dependency after aSAH.