Lumbar drainage for subarachnoid hemorrhage: technical considerations and safety analysis

Abstract

Recent and on going clinical research trials may indicate that the incidence of vasospasm is less in patients treated with lumbar drains following SAH than with patients treated with external ventricular drainage (EVD) alone. These studies have sparked interest in the more aggressive use of LDs in patients with aneurysmal SAH but some clinicians have been concerned about safety. This paper is a review of 25 patients with aneurysmal SAH cared for over a 2.2 year period at the University of Mississippi Medical Center Neurosciences Critical Care Unit that were managed with a LD. In general the LD was used subsequent to an EVD, but in some cases alone, in order to improve evacuation of blood from the cisterns around the base of the brain. This retrospective cohort review demonstrates that lumbar drainage is safe in the setting of aneurysmal SAH. Of the 25 patients treated with a lumbar drain only one suffered a reversible neurological event. No other complications occurred. LDs are safe when used in the setting of aneurysmal SAH if appropriate patient selection and good technique are employed.