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Published on: August 11, 2015
Risk factors of postoperative remote intracerebral hemorrhage after craniotomy for ruptured cerebral aneurysms
Insu Lee1, Cheol Wan Park1,2, Chan Jong You1,2
1Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.
Insights
Perioperative cerebrospinal fluid (CSF) drainage via lumbar drainage (LD) after craniotomy for ruptured aneurysms significantly increases the risk of postoperative remote intracerebral hemorrhage (rICH). Careful monitoring is crucial for patients undergoing LD.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Ruptured intracranial aneurysms often require craniotomy.
- Postoperative remote intracerebral hemorrhage (rICH) is a serious complication.
- The role of perioperative cerebrospinal fluid (CSF) drainage in rICH development is unclear.
Purpose of the Study:
- To investigate the association between perioperative lumbar drainage (LD) and the incidence of postoperative remote intracerebral hemorrhage (rICH) in patients undergoing craniotomy for ruptured intracranial aneurysms.
Main Methods:
- Retrospective review of 688 patients who underwent craniotomy for ruptured cerebral aneurysms between 1998 and 2004.
- Comparison of rICH incidence between patients with and without perioperative LD.
- Multivariate logistic regression analysis to identify independent risk factors for rICH.
Main Results:
- The incidence of POP rICH was significantly higher in the LD group (12.5%) compared to the non-LD group (0.8%).
- LD placement was identified as the sole independent risk factor for rICH development in multivariate analysis.
- Despite differences in hypertension history, surgery timing, and suction drain use, these were not independent risk factors for rICH.
Conclusions:
- Perioperative LD in craniotomy for ruptured intracranial aneurysms is associated with a significantly higher incidence of POP rICH.
- Close monitoring for POP rICH is recommended for patients managed with perioperative LD.
Objective:
We aimed to identify the relation between perioperative cerebrospinal fluid (CSF) drain through lumbar drainage (LD) and development of postoperative (POP) remote intracerebral hemorrhage (rICH) in craniotomy to treat ruptured intracranial aneurysms.
Methods:
We retrospectively reviewed consecutive patients who underwent craniotomy for ruptured cerebral aneurysms at the authors' institution between 1998 and 2004. We subsequently compared the incidence and characteristics of POP rICH between the patients who had a perioperative LD and those who did not. All statistical analyses were conducted using the software package SPSS 19.0 (SPSS Inc., Chicago, IL, USA). A p value of <0.05 was considered statistically significant.
Results:
We enrolled 688 patients, of which 80 patients (11.6%) received perioperative LD, and 608 did not. LD and non-LD groups were comparable because although clinical characteristics of the two groups were significantly different considering history of hypertension, timing of surgery, and closed system negative pressure suction drain (SD) placement, none of these three variables was an independent risk factor associated with POP rICH in multivariate analysis. POP rICH incidence was significantly higher in the LD goup (12.5%) than non-LD group (0.8%) (p=0.000) in univariate analysis. LD placement was the only independent risk factor associated with the development of rICH in multivariate logistic regression analysis.
Conclusions:
POP rICH incidence was significantly higher in patients who were managed with perioperative LD than in those who did not. LD insertion in craniotomy for ruptured intracranial aneurysm, should be closely monitored to address the occurrence of POP rICH.
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