Journal of Korean Neurosurgical Society

  • 제57권3호
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  • Pages.167-173
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  • 2015
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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The Effectiveness of Lumbar Cerebrospinal Fluid Drainage to Reduce the Cerebral Vasospasm after Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage

  • Park, Soojeong (Department of Neurosurgery, School of Medicine, Ewha Womans University) ;
  • Yang, Narae (Department of Neurosurgery, School of Medicine, Ewha Womans University) ;
  • Seo, Euikyo (Department of Neurosurgery, School of Medicine, Ewha Womans University)
  • 투고 : 2014.07.13
  • 심사 : 2014.12.15
  • 발행 : 2015.03.28
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초록

Objective : Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods : Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results : Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups. Conclusion : LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.

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참고문헌

  1. Carrera E, Schmidt JM, Oddo M, Fernandez L, Claassen J, Seder D, et al. : Transcranial Doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery 65 : 316-323; discussion 323-324, 2009 https://doi.org/10.1227/01.NEU.0000349209.69973.88
  2. Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. : Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage : the Fisher scale revisited. Stroke 32 : 2012-2020, 2001 https://doi.org/10.1161/hs0901.095677
  3. Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS : Bacterial meningitis associated with lumbar drains : a retrospective cohort study. J Neurol Neurosurg Psychiatry 67 : 468-473, 1999 https://doi.org/10.1136/jnnp.67.4.468
  4. Dietrich HH, Dacey RG Jr : Molecular keys to the problems of cerebral vasospasm. Neurosurgery 46 : 517-530, 2000 https://doi.org/10.1097/00006123-200003000-00001
  5. Ekelund A, Säveland H, Romner B, Brandt L : Is transcranial Doppler sonography useful in detecting late cerebral ischaemia after aneurysmal subarachnoid haemorrhage? Br J Neurosurg 10 : 19-25, 1996
  6. Eskridge JM, McAuliffe W, Song JK, Deliganis AV, Newell DW, Lewis DH, et al. : Balloon angioplasty for the treatment of vasospasm : results of first 50 cases. Neurosurgery 42 : 510-516; discussion 516-517, 1998 https://doi.org/10.1097/00006123-199803000-00016
  7. Findlay JM, Kassell NF, Weir BK, Haley EC Jr, Kongable G, Germanson T, et al. : A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery 37 : 168-176; discussion 177-178, 1995 https://doi.org/10.1227/00006123-199507000-00041
  8. Firlik KS, Kaufmann AM, Firlik AD, Jungreis CA, Yonas H : Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Surg Neurol 51 : 66-74, 1999 https://doi.org/10.1016/S0090-3019(97)00370-4
  9. Fisher CM, Kistler JP, Davis JM : Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6 : 1-9, 1980 https://doi.org/10.1227/00006123-198001000-00001
  10. Heros RC, Zervas NT, Varsos V : Cerebral vasospasm after subarachnoid hemorrhage : an update. Ann Neurol 14 : 599-608, 1983 https://doi.org/10.1002/ana.410140602
  11. Heuer GG, Smith MJ, Elliott JP, Winn HR, LeRoux PD : Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 101 : 408-416, 2004 https://doi.org/10.3171/jns.2004.101.3.0408
  12. Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H : Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : clinicoanatomic correlations. Neurology 36 : 329-333, 1986 https://doi.org/10.1212/WNL.36.3.329
  13. 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
  14. Hoh BL, Curry WT Jr, Carter BS, Ogilvy CS : Computed tomographic demonstrated infarcts after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 146 : 1177-1183, 2004 https://doi.org/10.1007/s00701-004-0349-6
  15. Inagawa T, Kamiya K, Matsuda Y : Effect of continuous cisternal drainage on cerebral vasospasm. Acta Neurochir (Wien) 112 : 28-36, 1991 https://doi.org/10.1007/BF01402451
  16. Juvela S : Plasma endothelin and big endothelin concentrations and serum endothelin-converting enzyme activity following aneurysmal subarachnoid hemorrhage. J Neurosurg 97 : 1287-1293, 2002 https://doi.org/10.3171/jns.2002.97.6.1287
  17. Kamezaki T, Yanaka K, Nagase S, Fujita K, Kato N, Nose T : Increased levels of lipid peroxides as predictive of symptomatic vasospasm and poor outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 97 : 1302-1305, 2002 https://doi.org/10.3171/jns.2002.97.6.1302
  18. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL : The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1 : Overall management results. J Neurosurg 73 : 18-36, 1990 https://doi.org/10.3171/jns.1990.73.1.0018
  19. 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
  20. Kawakami Y, Shimamura Y : Cisternal drainage after early operation of ruptured intracranial aneurysm. Neurosurgery 20 : 8-14, 1987 https://doi.org/10.1227/00006123-198701000-00003
  21. Kim DE, Suh YS, Lee MS, Kim KY, Lee JH, Lee HS, et al. : Vascular NAD(P)H oxidase triggers delayed cerebral vasospasm after subarachnoid hemorrhage in rats. Stroke 33 : 2687-2691, 2002 https://doi.org/10.1161/01.STR.0000033071.99143.9E
  22. Kodama N, Matsumoto M, Sasaki T, Konno Y, Sato T : Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm. Acta Neurochir Suppl 77 : 171-174, 2001
  23. Kodama N, Sasaki T, Kawakami M, Sato M, Asari J : Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surg Neurol 53 : 110-117; discussion 117-118, 2000 https://doi.org/10.1016/S0090-3019(99)00183-4
  24. Konno Y, Sato T, Suzuki K, Matsumoto M, Sasaki T, Kodama N : Sequential changes of oxyhemoglobin in drained fluid of cisternal irrigation therapy--reference to the effect of ascorbic acid. Acta Neurochir Suppl 77 : 167-169, 2001
  25. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P : Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 100 : 12-24, 1989 https://doi.org/10.1007/BF01405268
  26. Longstreth WT Jr, Nelson LM, Koepsell TD, van Belle G : Clinical course of spontaneous subarachnoid hemorrhage : a population-based study in King County, Washington. Neurology 43 : 712-718, 1993 https://doi.org/10.1212/WNL.43.4.712
  27. Mizoi K, Yoshimoto T, Takahashi A, Fujiwara S, Koshu K, Sugawara T : Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator. J Neurosurg 78 : 430-437, 1993 https://doi.org/10.3171/jns.1993.78.3.0430
  28. Mori K, Arai H, Nakajima K, Tajima A, Maeda M : Hemorheological and hemodynamic analysis of hypervolemic hemodilution therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 26 : 1620-1626, 1995 https://doi.org/10.1161/01.STR.26.9.1620
  29. Murayama Y, Malisch T, Guglielmi G, Mawad ME, Viñuela F, Duckwiler GR, et al. : Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms : report on 69 cases. J Neurosurg 87 : 830-835, 1997 https://doi.org/10.3171/jns.1997.87.6.0830
  30. Naidech AM, Bendok BR, Bassin SL, Bernstein RA, Batjer HH, Bleck TP : Classification of cerebral infarction after subarachnoid hemorrhage impacts outcome. Neurosurgery 64 : 1052-1057; discussion 1057-1058, 2009 https://doi.org/10.1227/01.NEU.0000343543.43180.9C
  31. 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
  32. Ohman J, Servo A, Heiskanen O : Effect of intrathecal fibrinolytic therapy on clot lysis and vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 75 : 197-201, 1991 https://doi.org/10.3171/jns.1991.75.2.0197
  33. Seiler RW, Binggeli R : Is cerebral vasospasm still a clinical problem? Acta Neurochir Suppl 77 : 1-4, 2001
  34. Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, et al : Assessment : transcranial Doppler ultrasonography : report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 62 : 1468-1481, 2004 https://doi.org/10.1212/WNL.62.9.1468
  35. Suarez JI, Qureshi AI, Yahia AB, Parekh PD, Tamargo RJ, Williams MA, et al. : Symptomatic vasospasm diagnosis after subarachnoid hemorrhage : evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med 30 : 1348-1355, 2002 https://doi.org/10.1097/00003246-200206000-00035
  36. Treggiari-Venzi MM, Suter PM, Romand JA : Review of medical prevention of vasospasm after aneurysmal subarachnoid hemorrhage : a problem of neurointensive care. Neurosurgery 48 : 249-261; discussion 261-262, 2001
  37. Tuettenberg J, Czabanka M, Horn P, Woitzik J, Barth M, Thomé C, et al. : Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. J Neurosurg 110 : 1200-1208, 2009 https://doi.org/10.3171/2008.10.JNS08293
  38. Zabramski JM, Spetzler RF, Bonstelle C : Chronic cerebral vasospasm : effect of volume and timing of hemorrhage in a canine model. Neurosurgery 18 : 1-6, 1986 https://doi.org/10.1227/00006123-198601000-00001

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  3. Management of delayed cerebral ischemia after subarachnoid hemorrhage vol.20, pp.None, 2015, https://doi.org/10.1186/s13054-016-1447-6
  4. Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care vol.29, pp.3, 2017, https://doi.org/10.1097/ana.0000000000000407
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  6. Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal rebleeding vol.128, pp.6, 2015, https://doi.org/10.3171/2017.2.jns162748
  7. Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal rebleeding vol.128, pp.6, 2015, https://doi.org/10.3171/2017.2.jns162748
  8. Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage? vol.20, pp.2, 2015, https://doi.org/10.7461/jcen.2018.20.2.87
  9. External Ventricular Drains After Subarachnoid Hemorrhage: Is Less More? vol.28, pp.2, 2018, https://doi.org/10.1007/s12028-017-0443-2
  10. The effect of anesthetic agents on cerebral vasospasms after subarachnoid hemorrhage : A retrospective study vol.97, pp.31, 2015, https://doi.org/10.1097/md.0000000000011666
  11. Predictive Value of Cerebral Autoregulation Impairment for Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis vol.126, pp.None, 2015, https://doi.org/10.1016/j.wneu.2019.02.188
  12. Effects of a new magnesium-rich artificial cerebrospinal fluid on contractile 5-hydroxytryptamine and endothelin receptors in rat cerebral arteries vol.41, pp.11, 2015, https://doi.org/10.1080/01616412.2019.1672383
  13. Impact of Neurapheresis System on Intrathecal Cerebrospinal Fluid Dynamics: A Computational Fluid Dynamics Study vol.142, pp.2, 2015, https://doi.org/10.1115/1.4044308
  14. The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoid hemorrhage with different bleeding amounts vol.43, pp.2, 2020, https://doi.org/10.1007/s10143-019-01116-1
  15. Trehalose decreases blood clotting in the cerebral space after experimental subarachnoid hemorrhage vol.82, pp.5, 2020, https://doi.org/10.1292/jvms.19-0201
  16. Intraventrikuläre Blutungen vol.16, pp.4, 2015, https://doi.org/10.1055/a-1166-0632
  17. Application effect of two modalities for placing lumbar drain catheters in patients with postcraniotomy aseptic meningitis vol.23, pp.None, 2015, https://doi.org/10.1016/j.inat.2020.100853