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Preventive effect of intermittent cerebrospinal fluid drainage for secondary chronic hydrocephalus after aneurysmal
Tomoyasu Yamanaka1, Yusuke Nishikawa1, Takashi Iwata2
1Department of Neurosurgery, Graduate School of Medical Science, Nagoya City University, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi, 467-8601, Japan.
Insights
Intermittent cerebrospinal fluid (CSF) drainage significantly reduces secondary chronic hydrocephalus (sCH) after subarachnoid hemorrhage (SAH) compared to continuous drainage. This method is effective regardless of SAH severity, except when acute hydrocephalus is present.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) can lead to secondary chronic hydrocephalus (sCH).
- The comparative efficacy of intermittent versus continuous cerebrospinal fluid (CSF) drainage for preventing sCH post-SAH is not well-established.
- This study aimed to evaluate intermittent CSF drainage's effectiveness in reducing sCH after aneurysmal SAH.
Purpose of the Study:
- To determine if intermittent cerebrospinal fluid (CSF) drainage is more effective than continuous CSF drainage in preventing secondary chronic hydrocephalus (sCH) following aneurysmal subarachnoid hemorrhage (SAH).
Main Methods:
- A cohort of 204 patients with aneurysmal SAH were analyzed, with 136 receiving continuous CSF drainage and 68 receiving intermittent CSF drainage.
- Logistic regression and Cox proportional hazards models were employed to assess the association between drainage methods and sCH development.
- Patient data were collected between 2007 and 2022.
Main Results:
- The incidence of sCH was significantly lower in the intermittent CSF drainage group (32.4%) compared to the continuous group (54.4%).
- Intermittent CSF drainage showed a reduced risk of sCH (multivariate OR 0.25; 95% CI 0.11-0.57) compared to continuous drainage.
- Effectiveness varied by SAH severity and presence of acute hydrocephalus; it was more effective in severe SAH and in patients without acute hydrocephalus.
Conclusions:
- Intermittent CSF drainage is a more effective strategy than continuous drainage for reducing sCH after aneurysmal SAH.
- While ineffective when acute hydrocephalus is present, intermittent drainage successfully reduces sCH development irrespective of the initial SAH severity.
- Findings support intermittent CSF drainage as a potentially superior method for managing SAH patients at risk of sCH.
Background:
The efficacy of intermittent cerebrospinal fluid (CSF) drainage compared with that of continuous CSF drainage in patients with subarachnoid hemorrhage (SAH) remains undetermined to date. Therefore, we investigated whether intermittent CSF drainage is effective in reducing secondary chronic hydrocephalus (sCH) after aneurysmal SAH.
Methods:
Overall, 204 patients (69 men and 135 women) treated for aneurysmal SAH between 2007 and 2022 were included in this study. Following SAH onset, 136 patients were managed with continuous CSF drainage, whereas 68 were managed with intermittent CSF drainage. Logistic regression analyses were used to calculate the age-adjusted and multivariate odds ratios for the development of sCH. The Cox proportional hazards regression model were used to compare the effects of intermittent and continuous CSF drainage on sCH development.
Results:
Overall, 96 patients developed sCH among the 204 patients with SAH. In total, 74 (54.4%) of the 136 patients managed with continuous CSF drainage developed sCH, whereas 22 (32.4%) of the 68 patients managed with intermittent CSF drainage developed sCH. This demonstrated that the rate of sCH development was significantly lower among patients managed with intermittent CSF drainage. Compared with continuous CSF drainage, intermittent CSF drainage exhibited a multivariate odds ratio (95% confidential interval) of 0.25 (0.11-0.57) for sCH development. Intermittent CSF drainage was more effective (0.20, 0.04-0.95) in patients with severe-grade SAH than in those with mild-grade SAH (0.33, 0.12-0.95). Intermittent CSF drainage was ineffective in patients with acute hydrocephalus (8.37, 0.56-125.2), but it was effective in patients without acute hydrocephalus (0.11, 0.04-0.31).
Conclusions:
Compared with continuous CSF drainage, intermittent drainage is more effective in reducing sCH after aneurysmal SAH. Although intermittent drainage was ineffective in cases of co-occurrence of acute hydrocephalus, it was effective in reducing sCH development regardless of the severity of initial symptoms at SAH onset.
