Panni Pietro, Donofrio Carmine Antonio, Barzaghi Lina Raffaella, Giudice Lodoviga, Albano Luigi, Righi Claudio, Simionato Franco, Scomazzoni Francesco, Cozzi Silvano, Calvi Maria Rosa, Beretta Luigi, Falini Andrea, Mortini Pietro
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroradiology, Interventional Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
J Clin Neurosci. 2019 Jun;64:64-70. doi: 10.1016/j.jocn.2019.04.010. Epub 2019 Apr 22.
The use of lumbar drain (LD) in the aneurysmal subarachnoid hemorrhage (aSAH) has been described to reduce cerebral vasospasm and delayed cerebral ischemia (DCI), with a lack of studies referring to high grade population. The purpose of our study is to assess safety and feasibility of LD in the poor grade aSAH population subjected to endovascular aneurysm occlusion. Twenty-four consecutive poor grade aSAH patients, defined as grade IV and V according to World Federation of Neurological Surgeons (WFNS) classification, subjected to endovascular aneurysm occlusion, were retrospectively reviewed. Details of CSF drainage via LD and related complications were analyzed. Ventriculo-lumbar pressure gradient (VLPG) lower than 6 mmHg was considered in order to start LD use. Good outcome was defined as modified Rankin Scale (mRS) 0-2. LD was started within 72 h since aSAH in 17 cases (70.8%), and in 7 cases (29.2%) it was delayed due to contraindications. The mean LD length was of 13.8 days. The median VLPG during drainage was 2 mmHg (IQR: 0-4). No cases of brain or spinal hemorrhage, permanent neurological worsening due to brain herniation were noted. Three cases (12.5%) of CSF infection and a related death (4.2%) were reported. The use of LD, in association with external ventricular drain (EVD), seems to be safe and feasible in the poor grade aSAH population. VLPG monitoring seems to play a key role in avoiding potentially severe complications.
腰椎引流（LD）用于动脉瘤性蛛网膜下腔出血（aSAH）已被描述为可减少脑血管痉挛和延迟性脑缺血（DCI），但缺乏针对高级别患者群体的研究。我们研究的目的是评估LD在接受血管内动脉瘤栓塞术的低级别aSAH患者中的安全性和可行性。对连续24例根据世界神经外科医师联合会（WFNS）分类为IV级和V级的低级别aSAH患者进行回顾性分析，这些患者均接受了血管内动脉瘤栓塞术。分析了通过LD进行脑脊液引流的细节及相关并发症。为开始使用LD，将脑室-腰椎压力梯度（VLPG）低于6 mmHg作为考量指标。良好预后定义为改良Rankin量表（mRS）评分为0-2分。17例（70.8%）患者在aSAH后72小时内开始使用LD，7例（29.2%）因禁忌症而延迟使用。LD的平均使用时长为13.8天。引流期间VLPG的中位数为2 mmHg（四分位间距：0-4）。未发现脑或脊髓出血、因脑疝导致永久性神经功能恶化的病例。报告了3例（12.5%）脑脊液感染病例及1例相关死亡病例（4.2%）。在低级别aSAH患者中，联合使用LD和外部脑室引流（EVD）似乎是安全可行的。VLPG监测似乎在避免潜在严重并发症方面起着关键作用。
