Internal Medicine Resident Kaiser Permanente Los Angeles Medical Center Los Angeles, California, United States
Introduction: Cerebrospinal fluid (CSF) diversion is typically performed with an external ventricular drain (EVD) for symptomatic hydrocephalus following subarachnoid hemorrhage. However, placement of a lumbar drain (LD) has also been studied to reduce the incidence of vasospasm. We performed a single center retrospective analysis to evaluate the safety of lumbar drain versus external ventricular drain for symptomatic hydrocephalus following subarachnoid hemorrhage.
Methods: Patients admitted for aneurysmal subarachnoid hemorrhage who developed symptomatic hydrocephalus were treated with external ventricular drain or lumbar drain depending on neurosurgeon preference. We retrospectively compared these two groups for drain complications, vasospasm intervention, and both short- and long-term outcomes.
Results: From 2018 to 2021, there were a total of 116 patients with aneurysmal subarachnoid hemorrhage requiring CSF diversion for hydrocephalus. There were 93 cases of EVD placement and 23 cases of LD placement. Overall drain complications were 18.28% with EVD and 13.04% with LD. EVD versus LD complications consisted of hemorrhage (1.08% vs. 0%), infection (4.3% vs. 8.7%), malfunction (7.5% vs. 0%), and replacement (12.95% vs. 4.35%). EVDs were replaced when malfunctioning due to clogging with either EVD (61.5%) or LD (38.46%). VPS was subsequently required in 23.66% of patients with EVD versus 8.7% in LD patients. Vasospasm intervention type and prevalence as well as outcome in terms of modified Rankin Scale (mRS) at discharge, 30 days, and 90 days were also analyzed.
Conclusion : Symptomatic hydrocephalus after aneurysmal subarachnoid hemorrhage is a common sequela. External ventricular drains have historically been used for CSF diversion. Our retrospective results from a single center indicate that lumbar drain usage for CSF diversion is associated with no overall increase in complications while decreasing the procedural risk. LD are less likely to malfunction and less likely to need replacement. Further prospective studies may be helpful in elucidating optimal CSF diversion for patients with this disease process.
