Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Role of Lumbar Drainage to Prevent Shunt-Dependent Hydrocephalus after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage in Good-Grade Patients

  • Yong, Cho-In (Department of Neurosurgery, College of Medicine, Ewha Womans University) ;
  • Hwang, Sung-Kyun (Department of Neurosurgery, College of Medicine, Ewha Womans University) ;
  • Kim, Sung-Hak (Department of Neurosurgery, College of Medicine, Ewha Womans University)
  • Received : 2010.08.06
  • Accepted : 2010.12.29
  • Published : 2010.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. Methods : One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. Results : One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. Conclusion : Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.

Keywords

References

  1. Auer LM, Mokry M : Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysmal surgery. Neurosurgery 26 : 804-808, 1990 https://doi.org/10.1227/00006123-199005000-00012
  2. Dehdashti AR, Rilliet B, Rufenacht DA, de Tribolet N : Shunt-dependent hydrocephalus after rupture of intracranial aneurysms : a prospective study of the influence of treatment modality. J Neurosurg 101 : 402-407, 2004 https://doi.org/10.3171/jns.2004.101.3.0402
  3. Dorai Z, Hynan LS, Kopitnik TA, Samson D : Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 52 : 763-769; discussion 769-771, 2003 https://doi.org/10.1227/01.NEU.0000053222.74852.2D
  4. Fanning NF, Willinsky RA, ter Brugge KG : Wall enhancement, edema, and hydrocephalus after endovascular coil occlusion of intradural cerebral aneurysms. J Neurosurg 108 : 1074-1086, 2008 https://doi.org/10.3171/JNS/2008/108/6/1074
  5. Fulop B, Deak G, Mencser Z, Kuncz A, BarzoP : Factors affecting the development of chronic hydrocephalus following subarachnoid hemorrhage, with special emphasis on the role of ventricular and lumbar drainage. Ideggyogy Sz; 62(7-8) : 255-261, 2009
  6. Graff-Radford NR, Torner J, Adams HP, Kassell NF : Factors asso-ciated with subarachnoid hemorrhage. Arch Neurol 46 : 744-752, 1989 https://doi.org/10.1001/archneur.1989.00520430038014
  7. Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B : Chronic shunt-depedent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery 44 : 503-509; discussion 509-512, 1999 https://doi.org/10.1097/00006123-199903000-00039
  8. Guglielmi G, Vinuela F, Dion J, Duckwiler G : Electrothrombosis of saccular aneurysms via endovascular approach. Part 2 : Preliminary clinical experience. J Neurosurg 75 : 8-14, 1991 https://doi.org/10.3171/jns.1991.75.1.0008
  9. Hasan D, Tanghe HL : Disturbance of cisternal blood in patients with acute hydrocephalus after subarachnoid hemorrhage. Ann Neurol 31 : 374-378, 1992 https://doi.org/10.1002/ana.410310405
  10. Hasan D, van Peski J, Loeve I, Krenning EP, Vermeulen M : Single photon emission computed tomography in patients with acute hydrocephalus or cerebral ischemia after subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 54 : 490-493, 1991 https://doi.org/10.1136/jnnp.54.6.490
  11. Hasan D, Vermeulen M, Wijdicks EF, Hijdra A, van Gijn J : Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20 : 747-753, 1989 https://doi.org/10.1161/01.STR.20.6.747
  12. Hoekema D, Schmidt RH, Ross I : Lumbar drainage for subarachnoid hemorrhage : technical considerations and safety analysis. Neurocrit Care 7 : 3-9, 2007 https://doi.org/10.1007/s12028-007-0047-3
  13. Huttner HB, Schwab S, Bardutzky J : Lumbar drainage for communicating hydrocephalus after ICH with ventricular hemorrhage. Neurocrit Care 5 : 193-196, 2006 https://doi.org/10.1385/NCC:5:3:193
  14. Inagawa T, Kamiya K, Matsuda T : Effect of continuous cisternal drainage on cerebral vasospasm. Acta Neurochir(Wien) 112 : 28-36, 1991 https://doi.org/10.1007/BF01402451
  15. Kasuya H, Shimuzu T, Kagawa M : The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage : a retrospective analysis of 108 patients. Neurosurgery 28 : 56-59, 1991 https://doi.org/10.1227/00006123-199101000-00009
  16. Kasuya H, Shimizu T, Kagawa M : The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage : a retrospective analysis of 108 patients. Neurosurgery 28 : 56-59, 1991 https://doi.org/10.1227/00006123-199101000-00009
  17. Kasuya H, Shimizu T, Okada T, Takahashi K, Summerville T, Kitamura K : A study of continuous cerebrospinal fluid drainage in patients with subarachnoid hemorrhage. No Shinkei Geka 16(5 Suppl) : 475- 481, 1988
  18. Klinge PM, Berding G, Brinker T, Knapp WH, Samii M : A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus. J Neurosurg 91 : 605-609, 1999 https://doi.org/10.3171/jns.1999.91.4.0605
  19. Kwon OY, Kim YJ, Kim YJ, Cho CS, Lee SK, Cho MK : The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 43 : 281-287,2008 https://doi.org/10.3340/jkns.2008.43.6.281
  20. Macdonald RL : Lumbar drainage after subarachnoid hemorrhage : does it reduce vasospasm and delayed hydrocephalus? Neurocrit Care 7 : 1- 2, 2007 https://doi.org/10.1007/s12028-007-0046-4
  21. Milhorat TH : Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 20 : 15-20, 1987 https://doi.org/10.1227/00006123-198701000-00004
  22. Mitha AP, Wong JH, Lu JQ, Morrish WF, Hudon ME, Hu WY : Communicating hydrocephalus after endovascular coiling of unruptured aneurysms : report of 2 cases. J Neurosurg 108 : 1241-1244, 2008 https://doi.org/10.3171/JNS/2008/108/6/1241
  23. Molyneux A, Kerr R, Stratton I,Sandercock P, Clarke M, Shrimpton J, et al. : International Subarachnoid Aneurysm Trial(ISAT) of neurological clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised trial. Lancet 360 : 1267-1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  24. Nakagomi T, Takagi K, Narita K, Nagashima H, Tamura A : Cisternal washing therapy for the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl 77 : 161-165, 2001
  25. de Oliveira JG, Beck J, Setzer M, Gerlach R, Vatter H, Seifert V, et al. : Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling : a single-institution series and meta-analysis. Neurosurgery 61 : 924-933, 2007 https://doi.org/10.1227/01.neu.0000303188.72425.24
  26. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, et al. : Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR 26 : 506-514, 2005
  27. Pietilä TA, Heimberger KC, Palleske H, Brook M : Influence of aneurysm location on the development of chronic hydrocephalus following SAH. Acta Neurochir (Wien) 137 : 70-73, 1995 https://doi.org/10.1007/BF02188784
  28. Sakaki S, Ohta S, Kuwabara H, Shiraishi M : The role of ventricular and cisternal drainage in the early operation for ruptured intracranial aneurysms. Acta Neurochir (Wien) 88 : 87-94, 1987 https://doi.org/10.1007/BF01404143
  29. Sethi H, Moore A, Dervin J, Clifton A, MacSweeney JE : Hydrocephalus: comparison of clipping and embolization in aneurysm treatment. J Neurosurg 92 : 991-994, 2000 https://doi.org/10.3171/jns.2000.92.6.0991
  30. Steinke D, Weir B, Disney L : Hydrocephalus following aneurysmal subarachnoid hemorrhage. Neurol Res 9 : 3-9, 1987 https://doi.org/10.1080/01616412.1987.11739764
  31. Vale FL, Bradley EL, Fisher WS 3rd : The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg 86 : 462-466, 1997 https://doi.org/10.3171/jns.1997.86.3.0462
  32. Varelas P, Helms A, Sinson G, Spanaki M, Hacein-Bey L : Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus. Neurocrit Care 4 : 223-228, 2006 https://doi.org/10.1385/NCC:4:3:223
  33. Vermeij FH, Hasan D, Vermeulen M, Tanghe HL, van Gijn J : Predictive factors for deterioration from hydrocephalus after subarachnoid hemorrhage. Neurology 44 : 1851-1855, 1994 https://doi.org/10.1212/WNL.44.10.1851
  34. Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F : Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol 53 : 119-124; discussion 124-125, 2000 https://doi.org/10.1016/S0090-3019(99)00185-8

Cited by

  1. Effect of Cisternal Drainage on the Shunt Dependency Following Aneurysmal Subarachnoid Hemorrhage vol.52, pp.5, 2012, https://doi.org/10.3340/jkns.2012.52.5.441
  2. Lumbar drains may reduce the need for permanent CSF diversion in spontaneous subarachnoid haemorrhage vol.27, pp.2, 2010, https://doi.org/10.3109/02688697.2012.743971
  3. Effect of Lumbar Drainage on Incidence of Shunt-Dependent Hydrocephalus in Patients with Subarachnoid Hemorrhage Due to Ruptured Aneurysm Who Underwent Coil Embolization vol.4, pp.2, 2010, https://doi.org/10.21129/nerve.2018.4.2.72
  4. Subarachnoid Hemorrhage Induces Dynamic Immune Cell Reactions in the Choroid Plexus vol.14, pp.None, 2010, https://doi.org/10.3389/fncel.2020.00018