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  • Spinal Cerebrospinal Fluid Drainage for Prevention of Vasospasm in Aneurysmal Subarachnoid Haemorrhage: A Prospective Randomized Controlled Study

    Final Number:
    183

    Authors:
    Sachin A Borkar M.B.B.S., M.Ch.

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Cerebral vasospasm following aneurysmal subarachnoid haemorrhage is a major cause of mortality and morbidity. The optimal management of vasospasm remains elusive. In this regard, we undertook a prospective, RCT to evaluate the effectiveness of lumbar cerebrospinal fluid (CSF) drainage for prevention of cerebral vasospasm and its sequelae.

    Methods: Patients with aneurysmal SAH who met the inclusion criteria were randomized into two groups –group I(30 patients) underwent lumbar CSF rainage, while group II(30 patients) did not. All patients underwent aneurysmal clipping. Both the groups received standard reatment except for lumbar CSF drainage. The outcome was measured in terms of - 1) Clinically evident vasospasm; 2) Vasospasm-related cerebral infarction; 3) Condition at discharge; 4) GOS at 1 & 3 months follow-up.

    Results: Lumbar cerebrospinal fluid (CSF) drainage conferred a statistically significant benefit reducing the incidence of clinical vasospasm from 63% (in non-LCSFD group) to 30% (in LCSFD group) (p value =0.01) and incidence of vasospasm related cerebral infarction from 53% (in non- LCSFD group) to 20%( in LCSFD group) (p value = 0.007). Incidence of vasospasm was quantitatively lower in lumbar CSF drain group across all Hunt & Hess grades, however it was statistically significant in SAH grade III( p value = 0.008). Mean duration of hospital stay was slightly lower in LCSFD group compared to non- LCSFD group, however it did not reach statistical significance. A higher Glasgow Outcome Score (GOS) was observed in LCSFD group at 1 and 3-months follow-up as compared to non- LCSFD group.

    Conclusions: Drainage of CSF through a lumbar drain following aneurysmal SAH caused a statistically significant reduction in the incidence of clinical and radiological vasospasm and its sequelae. It also shortens the overall duration of hospital stay and improves the outcome as evidenced by a better GOS score at 1 and 3-months follow-up. .

    Patient Care: the results of this prospective RCT will help in establishing the role of spinal CSF drainage in prevention of cerebral vasospasm following aneurysmal SAH and prevent the morbidity and mortality associated with it.

    Learning Objectives: To assess the efficacy of spinal CSF drainage for prevention of vasospasm in aneurysmal SAH

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