Lumbar drains may reduce the need for permanent CSF diversion in spontaneous subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) is well known to induce hydrocephalus. This is often, initially, treated with external ventricular drainage (EVD). We recently started, also, using lumbar drains (LD) in patients refractory to removal of their EVD as a bridge to permanent CSF diversion. LD were placed in 25 patients with spontaneous SAH. LD remained in place a mean of 6.7 days (range 4-16) prior to removal. Patients had a median Fisher Grade of 4, Hunt-Hess score of 4, and WFNS score of 4. Only 4 of 25 patients (16%) progressed to the need of permanent shunting, one of which occurred after delayed recurrent aneurysm rupture. Only 7 of 25 patients developed symptomatic vasospasm despite their high median Fisher Grade. Both the shunt rate and the symptomatic vasospasm rate in this series are much less than the historical series predict. This suggests that lumbar drains may reduce the need for shunting and decrease the rate of symptomatic vasospasm.