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Published on: June 18, 2021
Effects of lumbar drainage on CSF dynamics in subarachnoid hemorrhage condition: A computational study
Ehsan Abolfazli1, Nasser Fatouraee1, Amir Saeed Seddighi2
1Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
Insights
Lumbar drainage can help clear blood from the cerebrospinal fluid (CSF) spaces after subarachnoid hemorrhage. Higher drainage rates accelerate blood clearance, potentially reducing complications like cerebral vasospasm.
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Subarachnoid hemorrhage (SAH) treatment often involves lumbar drainage, but its efficacy remains debated.
- Blood in cerebrospinal fluid (CSF) spaces can lead to serious complications, including cerebral vasospasm.
Purpose of the Study:
- To investigate the effectiveness of lumbar drainage in clearing blood from CSF pathways following SAH.
- To model and quantify the impact of varying lumbar drainage rates on blood clearance.
Main Methods:
- Developed a subject-specific 3D model of CSF pathways using MRI data.
- Simulated subarachnoid hemorrhage and analyzed blood concentration dynamics.
- Calculated temporal variations in blood concentration for two different lumbar drainage rates.
Main Results:
- Lumbar drainage was observed to accelerate the clearance of blood and spasm-inducing agents from cranial and spinal subarachnoid spaces.
- Higher drainage rates resulted in significantly faster blood clearance from the CSF spaces.
Conclusions:
- Lumbar drainage is an effective method for accelerating the removal of blood and associated spasmogens after subarachnoid hemorrhage.
- Optimizing lumbar drainage rates may enhance therapeutic outcomes and reduce the risk of SAH complications.
Abstract:
Lumbar drainage is considered a therapeutic measure in treatment of subarachnoid hemorrhage. However, the evidence on the effectiveness of this method is still inconclusive. In this study, a subject-specific three dimensional model of the cerebrospinal fluid (CSF) pathways and compartments was developed. The ventricular and the cranial and spinal subarachnoid spaces were reconstructed using magnetic resonance images. Occurrence of subarachnoid hemorrhage was modeled. Since the presence of blood in the CSF spaces is known to be the cause of complications such as cerebral vasospasm, concentration of blood in these spaces was investigated. Two cases of lumbar drains that were different in the drainage rate were studied. Temporal variations of concentration of blood in CSF spaces were calculated. It was observed that lumbar drainage accelerates the clearance of blood and, thereby, the spasmogens present in the cranial and spinal subarachnoid space. Higher clearance rates were observed at higher drainage rates.
