Continued lumbar cerebrospinal fluid drainage in surgery for intracranial aneurysms

Abstract

Objective To compare the advantages and disadvantages of continuous lumbar cerebrospinal fluid drainage and repeated lumbar puncture for ruptured intracranial aneurysm surgery.Methods 295 patients were enrolled who had ruptured intracranial aneurysm and were treated surgically between Jan 2010 and Jan 2011 in department of neurosurgery.Patients were classified into 2 groups:patients who were performed with continuous lumbar cerebrospinal fluid drainage (group A) and patients who were performed with repeated lumbar puncture (group B).The incidence rates of major surgical complications of both groups were compared and analyzed,including delayed cerebral ischemia,postsurgical hydrocephalus and postsurgical intracranial infection.All patients were followed-up for over 6 months and the surgical outcomes were assessed using modified Rankin scale (mRS).Results The incidence rates of delayed cerebral ischemia were 4.38％ (7/160) and 7.41％ (10/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of postsurgical hydrocephalus were 2.50％ (4/160) and 3.70％ (5/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of intracranial infection were 8.13％ (13/160) and 2.22％ (3/135) in group A and B respectively.There was a higher rate of intracranial infection in group A (P ＜ 0.05).There was no significant difference in mRS between 2 groups after 6-months follow-up.Conclusions Continuous lumbar cerebrospinal fluid drainage showed little advantage over repeated lumbar puncture in reducing the occurrence of major surgical complications,including delayed cerebral ischemia and postsurgical hydrocephalus.While continuous lumbar cerebrospinal fluid drainage had a higher incidence rate of intracranial infection.Continuous Lumbar cerebrospinal fluid drainage might enhance the risk of intracranial infection.The therapeutic indications of continuous lumbar cerebrospinal fluid drainage for ruptured intracranial aneurysm surgery should be considered carefully.The standardized surgical operations should be followed strictly and the importance of asepsis during the surgery should be valued. Key words: Intracranial aneurysm ; Cerebrospinal fluid ; Brain ischemia ; Hydrocephalus ; Central nervous system infections