Effect of continuous cisternal cerebrospinal fluid drainage for patients with thin subarachnoid hemorrhage

Yasunari Otawara, Kuniaki Ogasawara, Yoshitaka Kubo, Masayuki Sasoh, Akira Ogawa

Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan

Abstract: External cerebrospinal fluid (CSF) drainage is an effective method to remove massive subarachnoid hemorrhage (SAH), but carries the risk of meningitis and shunt-dependent hydrocephalus. This study investigated whether postoperative cisternal CSF drainage affects the incidence of cerebral vasospasm and clinical outcome in patients with thin SAH. Seventy-eight patients with thin SAH, 22 men and 56 women aged from 17 to 73 years (mean 51.2 years), underwent surgical repair for ruptured anterior circulation aneurysm. Patients were divided into groups with (38 patients) and without (40 patients) postoperative cisternal CSF drainage, and the incidences of angiographical and symptomatic vasospasm, shunt-dependent hydrocephalus, meningitis, and the clinical outcome were compared. The incidences of angiographical vasospasm (31.6% vs 50.0%), symptomatic vasospasm (7.9% vs 12.5%), shunt-dependent hydrocephalus (5.3% vs 0%), and meningitis (2.6% vs 0%) did not differ between patients with and without cisternal CSF drainage. All patients in both groups resulted in good recovery. Postoperative cisternal CSF drainage does not affect the incidence of cerebral vasospasm or the clinical outcome in patients with thin SAH.

Keywords: subarachnoid hemorrhage; cerebrospinal fluid drainage; cerebral vasospasm; meningitis; hydrocephalus; ruptured intracranial aneurysm