Related Experiment Video
Updated: May 7, 2026
The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects
Published on: October 2, 2014
The effect of temporary CSF diversion modality on shunt-dependency following aneurysmal subarachnoid hemorrhage: A
Michelle Lin1, Jonathan Dallas1, Li Ding1
1Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Insights
Temporary cerebrospinal fluid diversion using both external ventricular drains (EVD) and lumbar drains (LD) in aneurysmal subarachnoid hemorrhage (aSAH) patients was associated with increased shunt placement and bacterial meningitis. Further research is needed to determine if LD placement effectively reduces long-term shunt dependence.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) presents significant morbidity and economic burden in the US.
- Chronic shunt-dependent hydrocephalus is a common complication following aSAH.
- Temporary cerebrospinal fluid (CSF) diversion aims to mitigate these complications.
Purpose of the Study:
- To evaluate outcomes of temporary bedside CSF diversion in aSAH patients.
- To compare the efficacy of external ventricular drain (EVD), lumbar drain (LD), or combined EVD+LD placement.
- To assess the impact on shunt placement rates and other adverse events.
Main Methods:
- Nationwide Inpatient Sample (NIS) database (2016-2020) analysis.
- Inclusion of adult patients with non-traumatic SAH treated with aneurysm clipping or coiling.
- Comparison of outcomes for patients receiving EVD, LD, or EVD+LD for temporary CSF diversion.
Main Results:
- 18.42% of aSAH patients required permanent CSF diversion.
- Patients receiving EVD+LD had higher rates of shunt placement (OR 1.624) and bacterial meningitis (OR 8.715).
- LD alone group tended to have healthier patient profiles.
Conclusions:
- Combined EVD and LD placement in aSAH is linked to increased shunt dependency and infectious complications.
- Results suggest caution when using combined EVD and LD for CSF diversion.
- Further investigation is required to confirm the efficacy of LD in reducing chronic shunt dependence.
Background:
Aneurysmal subarachnoid hemorrhage (aSAH) carries a high economic cost and clinical morbidity in the United States. Beyond prolonged admissions and poor post-injury functional status, there is an additional cost of chronic shunt-dependent hydrocephalus for many aSAH patients. Adjuvant lumbar drain (LD) placement has been hypothesized to promote clearance of subarachnoid blood from the cisternal space, with an ultimate effect of decreasing shunt placement rates. In this nationwide database study, we aim to evaluate outcomes associated with different forms of temporary bedside cerebrospinal fluid (CSF) diversion in the aSAH patient cohort.
Methods:
Inpatient admissions were queried from the National Inpatient Sample (NIS; 2016-2020). Inclusion criteria included adult patients presenting with non-traumatic SAH that underwent treatment with either non-elective clip ligation or coil embolization of their underlying aneurysms and received either an external ventricular drain (EVD), lumbar drain (LD), or both (EVD + LD) for temporary CSF diversion during that admission. Outcome variables evaluated included inpatient mortality, bacterial meningitis, length of stay, discharge disposition, and need for shunt placement.
Results:
A total of 5505 admissions met inclusion criteria, of which 18.42 % required permanent CSF diversion. The majority of patients received EVD alone (4842, 87.96 %). The remaining patients were split between LD alone (366, 6.65 %) or EVD + LD placement (297, 5.4 %). Patients receiving LD alone tended to be healthier, with lower rates of extreme APR-DRG subclass, Elixhauser Comorbidity Index (ECI), and NIS SAH Severity Score (NIS-SSS). Patients in the EVD + LD cohort had higher rates of shunt placement (OR 1.624, p = 0.0009) and higher rates of bacterial meningitis (OR 8.715, p < 0.0001), even when controlling for APR-DRG illness severity and ECI.
Conclusion:
Our study found higher rates of permanent CSF diversion, longer lengths of stay, and higher rates of bacterial meningitis in patients receiving both EVD and LD placement. Due to limitations inherent to nationwide database studies, these results should be interpreted cautiously. Further studies are needed to clarify whether adjuvant temporary CSF diversion with LD placement in the aSAH cohort for intent of minimizing chronic shunt-dependence is efficacious.
