An Xiuhu, Wang Bangyue, Ge Xinbo, Guo Yang, Yu Han, Li Tianxing, Feng Lei, Zhao Yan, Yang Xinyu
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Int J Stroke. 2025 May 12:17474930251342892. doi: 10.1177/17474930251342892.
There is no universally recognized optimal cerebrospinal fluid (CSF) drainage strategy. This study aimed to comprehensively compare the efficacy and safety of external ventricular drainage (EVD) and lumbar drainage (LD) in the management of aneurysmal subarachnoid hemorrhage (aSAH).
We consecutively included aSAH patients who underwent surgical treatment with CSF drainage between January 2017 and December 2020 in the Chinese Multicenter Cerebral Aneurysm Database (CMAD). After 1:1 propensity score matching (PSM), intergroup outcomes and in-hospital complications were compared between the EVD and LD groups. The Generalized Estimating Equation (GEE) model was used to assess the relationship between the drainage method and intergroup outcomes. Kaplan-Meier curves were used to analyze survival, and Cox proportional hazard modeling was performed to identify risk factors for mortality.
952 aSAH patients were initially included. After PSM, 167patients receiving EVD were matched with 167 patients receiving LD, resulting in a total of 334 patients for the matched analysis. Patients receiving EVD had higher 2-year mortality (27.1% vs 15.1%, p=0.011) and worse functional outcomes at discharge (45.5% vs 34.0%, adjusted OR 0.567 95% CI 0.324-0.991, p=0.046). However, functional outcomes at 2 years did not show significant differences (23.4% vs 22.0%, adjusted OR 0.811 95% CI 0.375-1.754, p=0.594). No differences were observed in in-hospital complication rates between the two groups. Multivariable Cox proportional hazard modeling identified WFNS grade IV-V as a risk factor for mortality in the EVD group. In the LD group, mortality risk factors included age ≥65 years, and diabetes.
LD demonstrated significant advantages in short-term functional outcomes, and long-term survival outcomes, but did not demonstrate significant differences in long-term functional outcomes and in-hospital complications. Risk factors identified in the prognostic analysis may inform clinical decision-making.
目前尚无普遍认可的最佳脑脊液（CSF）引流策略。本研究旨在全面比较脑室外引流（EVD）和腰大池引流（LD）在动脉瘤性蛛网膜下腔出血（aSAH）治疗中的疗效和安全性。
我们连续纳入了2017年1月至2020年12月在中国多中心脑动脉瘤数据库（CMAD）中接受CSF引流手术治疗的aSAH患者。经过1:1倾向评分匹配（PSM）后，比较EVD组和LD组的组间结局和院内并发症。使用广义估计方程（GEE）模型评估引流方法与组间结局之间的关系。采用Kaplan-Meier曲线分析生存率，并进行Cox比例风险建模以确定死亡风险因素。
最初纳入952例aSAH患者。经过PSM后，167例接受EVD的患者与167例接受LD的患者匹配，共有334例患者进行匹配分析。接受EVD的患者2年死亡率较高（27.1%对15.1%，p = 0.011），出院时功能结局较差（45.5%对34.0%，调整后OR 0.567，95%CI 0.324 - 0.991，p = 0.046）。然而，2年时的功能结局无显著差异（23.4%对22.0%，调整后OR 0.811，95%CI 0.375 - 1.754，p = 0.594）。两组间院内并发症发生率无差异。多变量Cox比例风险建模确定WFNS IV - V级为EVD组死亡的风险因素。在LD组中，死亡风险因素包括年龄≥65岁和糖尿病。
LD在短期功能结局和长期生存结局方面显示出显著优势，但在长期功能结局和院内并发症方面未显示出显著差异。预后分析中确定的风险因素可为临床决策提供参考。
