Journal of Korean Society of Geriatric Neurosurgery 2012;8(2):92-98.
Published online December 30, 2012.
Effects of Cerebrospinal Fluid Drainage in Patients with Subarachnoid Hemorrhage from Posterior Circulation Aneurysm Rupture
Keuk Kyu Park , Ki Young Han , Jae Young Yang , Chun Sik Choi , Yu Sam Won
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Cerebral vasospasm is perceived as a major source of morbidity in patients with aneurysmal subarachnoid hemorrhage (SAH). There are multimodal strategies for the prevention of vasospasm, including calcium channel blockers, triple H therapy, and mechanical and chemical angioplasty, among other preventive strategies. The drainage of external cerebrospinal fluid (CSF) is also effective for the prevention of vasospasm by way of removing subarachnoid hemorrhages and spasmogens. Much of the existing literature about the topic, however, is limited in that itevaluates the effectiveness of external CSF drainage only in patients that suffer from anterior circulation aneurysmal subarachnoid hemorrhages.The present study investigates whether the drainage of external CSF in a group of SAH patients with ruptured posterior circulation aneurysms affects the incidence of cerebral vasospasm and clinical outcomes.
This study is based on a series of 179 consecutive patients with aneurysmal SAH diagnosed at the Kangbuk Samsung Hospital between January 2007 and December 2010. Of the total patients, the medical trajectory of 18 patients fit the study criteria, including endovascular intervention performed within 48 hours from the time of admission, patient survival for at least 3 days, and posterior circulation aneurysmal rupture. Patients were divided into groups with and without post-intervention external CSF drainage. Both external ventricular drain (EVD) and lumbar drain (LD) procedures were considered external CSF drainage. The incidence of vasospasm and clinical outcomes by GOS scores were compared between the two groups.
The age of patients ranged from 52 to 75 years (the average age was 64.4 years). There were 7 men and 11 women. The initial symptoms were headaches, seizures, and decreased mentality, among other symptoms. Judging from our results, external CSF drainage did not reduce the incidence of clinical vasospasm. Furthermore, comparative GOS scores at the time of patient discharge were as bad in the group of patients with external CSF drainage as in the group of patients without external CSF drainage (p=0.043).
Our study shows that, unlike in patients with ruptured anterior circulation aneurysms, appropriate CSF drainage does not significantly affect the degree of vasospasm and clinical outcomes in patients with ruptured posterior circulation aneurysms.
Key Words: Subarachnoid hemorrhageㆍCerebrospinal fluid drainageㆍVasospasmㆍPosterior circulation aneurysmㆍClinical outcomes

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