Blackburn Spiros L, Babi Marc A, Grande Andrew W, Choudhri Omar A, Hauck Erik F, Kellner Christopher P, Giordano Michael C, Lad Shivanand P, McCabe Aaron R
The Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Neurosurgery, Neuroscience Institute, Cleveland Clinic, Port St. Lucie, FL, USA.
Neurocrit Care. 2025 Jul 31. doi: 10.1007/s12028-025-02328-8.
There is a growing consensus that blood in the cerebrospinal fluid (CSF) is deleterious to outcomes in patients with aneurysmal subarachnoid hemorrhage. The extracorporeal filtration of subarachnoid hemorrhage via spinal catheter extension study evaluated the safety, tolerability, and filtration curve of blood and its lysis products from hemorrhagic CSF using the Neurapheresis CSF Management System.
After aneurysm repair, a dual-lumen intrathecal catheter was inserted into the study participant's spinal canal. CSF was extracorporeally filtered for up to 72 h, removing blood products from the lumbar cistern, and reintroducing filtered CSF to the thoracic subarachnoid space. Neurological examinations were performed every 2 h, computed tomography scans were captured five times, and CSF samples were evaluated for cell counts every 8 h. Clinical follow-up evaluations were conducted 2 and 30 days after treatment.
Twenty-seven of 29 study participants (93%) had a catheter successfully inserted. The median rate of waste removal was 5.7 mL/hr (interquartile range 3.9-8.8), and the median CSF filtration duration was 37:00 h (interquartile range 24:03-38:52). CSF red blood cell (mean reduction of 86%) and protein cell counts (mean reduction of 82%) decreased much faster in Neurapheresis system-treated participants compared with published data from standard-of-care patients with aneurysmal subarachnoid hemorrhage. From study participant screening through catheter removal, intracranial blood (evaluated via Hijdra Sum Score) decreased by 65%. In four study participants, there were a total of five adverse events, among whom one was determined per protocol to be a serious adverse event. All five events were mild or moderate severity and resolved with no clinical sequelae.
The Extracorporeal Filtration of Subarachnoid Hemorrhage Via Spinal Catheter Extension study demonstrated the potential to significantly accelerate intracranial blood elimination based on imaging (Hijdra Sum Score) and CSF red blood cell and protein reduction measures via a closed-loop filtration system.
越来越多的共识认为，脑脊液（CSF）中的血液对动脉瘤性蛛网膜下腔出血患者的预后有害。蛛网膜下腔出血经脊髓导管延长体外滤过研究使用神经血液滤过脑脊液管理系统评估了出血性脑脊液中血液及其溶解产物的安全性、耐受性和滤过曲线。
动脉瘤修复术后，将双腔鞘内导管插入研究参与者的椎管。脑脊液进行体外滤过长达72小时，从腰大池清除血液产物，并将滤过的脑脊液重新引入胸段蛛网膜下腔。每2小时进行一次神经学检查，进行5次计算机断层扫描，每8小时评估一次脑脊液样本的细胞计数。在治疗后2天和30天进行临床随访评估。
29名研究参与者中有27名（93%）成功插入了导管。废物清除的中位数速率为5.7毫升/小时（四分位间距3.9 - 8.8），脑脊液滤过的中位数持续时间为37:00小时（四分位间距24:03 - 38:52）。与已发表的动脉瘤性蛛网膜下腔出血标准治疗患者的数据相比，神经血液滤过系统治疗的参与者脑脊液红细胞（平均减少86%）和蛋白质细胞计数（平均减少82%）下降得更快。从研究参与者筛选到导管拔除，颅内血液（通过Hijdra总和评分评估）减少了65%。在4名研究参与者中，共有5起不良事件，其中1起根据方案被判定为严重不良事件。所有5起事件均为轻度或中度严重程度，且无临床后遗症地得到解决。
蛛网膜下腔出血经脊髓导管延长体外滤过研究表明，基于成像（Hijdra总和评分）以及通过闭环滤过系统使脑脊液红细胞和蛋白质减少的措施，有可能显著加速颅内血液清除。
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