Serial lumbar puncture reduces cerebrospinal fluid (CSF) infection during removal of hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling

Liang Chen,Guo Shiwen,Yang Ling

doi:10.7555/jbr.32.20170028

Abstract

The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture (LP) and lumbar cerebrospinal fluid (CSF) drainage (LD) of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management. In this retrospective study, 41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group, respectively. Clinical outcomes, including CSF infection, intracerebral hemorrhage, vasospasm, hydrocephalus, death, length of stay, duration of drainage and the Glasgow Outcome Scale score were compared between the two groups. By comparing with the LP group, the LD group showed a significantly higher rate of CSF infection (P=0.029) and shorter duration of drainage (P<0.001). Both groups displayed similar rates of vasospasm, hydrocephalus, intracerebral hemorrhage, the Glasgow Outcome Scale score one month after endovascular coiling and length of stay (P>0.05, respectively). In conclusion, both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides, serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.

Highlights

As a disease needing neurosurgery, aneurysmal subarachnoid hemorrhage is characterized with high morbidity and mortality
Various studies have revealed that early removal of hemorrhagic cerebrospinal fluid (CSF) after the onset of aneurysmal subarachnoid hemorrhage (aSAH) can significantly cut down the incidence of vasospasm and hydrocephalus associated with aSAH[3–4]
The inclusion criteria were (1) spontaneous primary aSAH confirmed by CT scan and digital subtraction angiography (DSA); (2) Hunt & Hess grades II to IV; (3) Fisher grades 2, 3, 4; (4) receiving the endovascular coiling within 36 hours after admission and receiving hemorrhagic CSF drainage less than 48 hours after onset

Summary

Introduction

As a disease needing neurosurgery, aneurysmal subarachnoid hemorrhage (aSAH) is characterized with high morbidity and mortality. Emergency treatments and operations have lowered the mortality rate of aSAH, the overall outcome is still undermined by some complications, such as vasospasm and hydrocephalus[1]. The pathophysiology of aSAH is not completely known, while, undoubtedly, the presence of blood in the subarachnoid space is one important factor associated with these complications[2]. Removal of bloody cerebrospinal fluid (CSF) plays an important role in the management of aSAH. Various studies have revealed that early removal of hemorrhagic CSF after the onset of aSAH can significantly cut down the incidence of vasospasm and hydrocephalus associated with aSAH[3–4]. There exist three primary methods to drain hemorrhagic CSF: serial lumbar puncture (LP), lumbar CSF drainage (LD) and external ventricular drainage

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Conclusion