Cerebrospinal fluid lumbar drainage in reducing vasospasm following aneurysmal subarachnoid hemorrhage in Vietnam: A single-center prospective study

Abstract

Objective: Vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) aggravates outcome of patients through a cascade of complications and harsh consequences. This study was conducted to evaluate the effect of cerebrospinal fluid (CSF) lumbar drainage in aSAH management and in the prevention of vasospasm at a university hospital in Vietnam. Methods: A single-center, prospective case series of aSAH treatment with CSF lumbar drainage was conducted from June 2018 to July 2019. Outcomes measured were clinical vasospasm, vasospasm-induced infarction, shunt-dependent rate, duration of treatment in hospital and Glasgow Outcome Scale (GOS) at 3 months and 1 year after discharge. Results: Among 43 patients with aSAH admitted to the clinic, thirty-two aSAH patients (71.8% female, mean age 58.8 ± 11.5 years) received lumbar drainage. The incidence of clinical vasospasm and vasospasm-induced infarction on CT scan/MRI (including asymptomatic cerebral infarction) was 21.9% and 56.3%, respectively. Four patients (12.5%) underwent another CSF shunting operation. The mean duration of hospital stay was 27.8 ± 16.9 days. Nearly 70% of aSAH patients were discharged and were able to return to normal life with no or minor neurological deficits (GOS 4–5) at 3-month and 1-year follow-ups. No serious complication of CSF lumbar drainage was observed, except for one major setback, which was meningitis during treatment (53.1%). Conclusions: CSF lumbar drainage may reduce the incidence of clinical vasospasm, shorten hospital stays, and possibly improve patient outcomes following aSAH. Our findings suggest that the selective use of CSF lumbar drainage, in addition to standard strategies, can be beneficial in preventing vasospasm and offers more choice in aSAH management.

Keywords

• Aneurysmal subarachnoid hemorrhage
• Cerebrospinal lumbar drainage
• Vasospasm