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Früh A, Truckenmüller P, Wasilewski D, Vajkoczy P, Wolf S. Analysis of Cerebral Spinal Fluid Drainage and Intracranial Pressure Peaks in Patients with Subarachnoid Hemorrhage. Neurocrit Care 2024:10.1007/s12028-024-01981-9. [PMID: 38622488 DOI: 10.1007/s12028-024-01981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND After aneurysmal subarachnoid hemorrhage (aSAH), elevated intracranial pressure (ICP) due to disrupted cerebrospinal fluid (CSF) dynamics is a critical concern. An external ventricular drainage (EVD) is commonly employed for management; however, optimal strategies remain debated. The randomized controlled Earlydrain trial showed that an additional prophylactic lumbar drainage (LD) after aneurysm treatment improves neurological outcome. We performed a post hoc investigation on the impact of drainage volumes and critical ICP values on patient outcomes after aSAH. METHODS Using raw patient data from Earlydrain, we analyzed CSF drainage amounts and ICP measurements in the first 8 days after aSAH. Outcomes were the occurrence of secondary infarctions and the score on the modified Rankin scale after 6 months, dichotomized in values of 0-2 as favorable and 3-6 as unfavorable. Repeated measurements were considered with generalized estimation equations. RESULTS Earlydrain recruited 287 patients, of whom 221 received an EVD and 140 received an LD. Higher EVD volumes showed a trend to more secondary infarctions (p = 0.09), whereas higher LD volumes were associated with less secondary infarctions (p = 0.009). The mean total CSF drainage was 1052 ± 659 mL and did not differ concerning infarction and neurological outcome. Maximum ICP values were higher in patients with poor outcomes but not related to drainage volumes via EVD. After adjustment for aSAH severity and total CSF drainage, higher LD volume was linked to favorable outcome (per 100 mL: odds ratio 0.61 (95% confidence interval 0.39-0.95), p = 0.03), whereas higher EVD amounts were associated with unfavorable outcome (per 100 mL: odds ratio 1.63 (95% confidence interval 1.05-2.54), p = 0.03). CONCLUSIONS Findings indicate that effects of CSF drainage via EVD and LD differ. Higher amounts and higher proportions of LD volumes were associated with better outcomes, suggesting a potential quantity-dependent protective effect. Optimizing LD volume and mitigating ICP spikes may be a strategy to improve patient outcomes after aSAH. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01258257.
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Affiliation(s)
- Anton Früh
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- BIH Charité Junior Digital Clinician Scientist Program, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Truckenmüller
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - David Wasilewski
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Wolf
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
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Le VT, Nguyen AM, Nguyen PL. Risk Factors for In-Hospital Seizure and New-Onset Epilepsy in Coiling and Clipping Treatment of Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2024; 184:e460-e467. [PMID: 38310946 DOI: 10.1016/j.wneu.2024.01.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To identify risk factors associated with in-hospital seizures and new-onset epilepsy in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent coiling embolization or clipping surgery. METHODS This retrospective descriptive study included 195 patients diagnosed with aneurysmal SAH and treated with coiling embolization or clipping surgery between January 2018 and June 2022. RESULTS Among the 195 patients meeting inclusion criteria, 9 experienced an onset seizure at the time of SAH. In-hospital seizures were observed in 33 patients, of which 24 were electrographic seizures detected in 24 patients with suspected subclinical seizures. After 12 months of follow-up, 11 patients met criteria for diagnosis of epilepsy. The incidence of epilepsy after discharge at 12 months was 2.41% in the coiling group and 8.03% in the clipping group. The risk of in-hospital seizures was significantly higher in the clipping group (P = 0.007), although the difference was not statistically significant after 12 months of follow-up (P = 0.121). CONCLUSIONS Epilepsy following aneurysmal SAH was relatively common. Clipping surgery and brain edema emerged as independent predictive factors for in-hospital seizures, while onset seizures and in-hospital seizures were identified as independent predictors of epilepsy during follow-up. Patients presenting with these risk factors may benefit from long-term electroencephalogram monitoring and should be considered for prophylactic antiepileptic drugs. Additionally, lumbar drainage proved effective in improving both early and late epileptic outcomes in the group with Fisher grades 3 and 4.
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Affiliation(s)
- Viet-Thang Le
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Anh Minh Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Phuc Long Nguyen
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam.
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Kim JY, Oh BH, Kim IS, Hong JT, Sung JH, Lee HJ. The safety and effectiveness of lumbar drainage for cerebrospinal fluid leakage after spinal surgery. Neurochirurgie 2023; 69:101501. [PMID: 37741364 DOI: 10.1016/j.neuchi.2023.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Cerebrospinal fluid (CSF) leakage is a frequent complication after spinal surgery. The lumbar drainage procedure (LDP) is the preferred method for early closure of a dural tear. This study was conducted to assess the safety and effectiveness of LDP after spinal surgery. MATERIALS AND METHODS We retrospectively reviewed 122 patients (55 male and 67 female) who underwent LDP after spinal surgery between January 2010 and June 2021. LDP was performed on patients with suspected CSF leakage due to a dural tear during spinal surgery or in whom mixed-color CSF was observed in the hemo-drain after surgery. LDP was performed aseptically by a resident according to our institution's protocol, and the amount drained was from 200cc to 300cc per day. Absolute bed rest was maintained during the lumbar drainage period. The hemo-drain was opened to confirm that CSF was no longer mixed or oozing, at which time the lumbar drain was removed. Culture was performed at the drain tip when the lumbar drain was removed. RESULTS The spinal surgery level was cervical in 23 patients, thoracic in 27 patients, and lumbar in 72 patients. The mean duration of the indwelling lumbar drain was 7.2 days (2 days-18 days), and the mean amount of drainage was 1198.2cc (100cc-2542cc). Among the 122 patients, the CSF leakage in 101 patients was resolved with the initial procedure, but 21 patients required re-insertion. Of those 21 patients, improper insertion due to a technical problem occurred in 15 patients, poor line fixation occurred in 2 patients, and CSF leakage was again observed after removal of the lumbar drain in 4 patients. In only 1 case was open surgery done after LDP because follow-up magnetic resonance imaging showed a suspected infection. During lumbar drainage, 76 patients used antibiotics, and 46 patients did not. Four patients showed bacterial growth in the tip culture, and 3 of them had been using antibiotics. All 4 of those patients were treated without complications and discharged. Among the 122 patients, 1 patient was discharged with left hemiparesis due to cerebral venous infarction (CVI) and hemorrhage after LDP, and 1 patient underwent re-operation because the CSF collection was not resolved. CONCLUSIONS No major complications such as systemic infection, deep vein thrombosis, or aspiration pneumonia occurred during the lumbar drainage, except for 1 patient (0.8%) with CVI caused by over-drainage. One patient (0.8%) required open surgery after LDP, but no cases of systemic infection occurred while maintaining lumbar drainage, irrespective of antibiotic use. In conclusion, LDP is a safe and effective treatment for CSF leakage after spinal surgery.
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Affiliation(s)
- Jee Yong Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Cheongju, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea.
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Zhang Y, Wu Y, Wu Y, Zhu G, Xue Y, Qu Y, Zhao T. The effect of postoperative early lumbar drainage on delayed fever after cerebellopontine angle tumour surgery: study protocol for a randomized controlled trial. Trials 2022; 23:1008. [PMID: 36510288 PMCID: PMC9746070 DOI: 10.1186/s13063-022-06950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Postoperative fever is one of the common complications in neurosurgery, and intracranial aseptic inflammation and infection are important risk factors. Continuous drainage of cerebrospinal fluid (CSF) via lumbar drainage (LD) is often used in the treatment of postoperative intracranial infection or aseptic inflammation. Compared with the previously reported placement of LD after the onset of meningitis symptoms, we designed this randomized controlled trial (RCT) to evaluate the effectiveness and safety of early drainage (1st day postoperation) of CSF using the preset lumbar cistern to prevent delayed fever (fever occurred after the third day postoperation) or reduce its treatment time after cerebellopontine angle (CPA) tumour surgery. METHODS Patients suffering from CPA tumours and who underwent resection of the tumour with an intraoperative dura opening time > 4 h are recruited for this study. The study is a 2-arm RCT to compare the early LD group and the no early LD group. Postoperative duration and rate of delayed fever and postoperative length of stay (LOS), as the main outcomes, will be compared in the two groups. DISCUSSION Here, we present the study design of a prospective RCT to evaluate the safety and efficacy of using preoperative preset LD to treat or reduce postoperative delayed fever. TRIAL REGISTRATION China Clinical Trial Registry ChiCTR2100049057. Registered on July 20, 2021.
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Affiliation(s)
- Yunze Zhang
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Yingxi Wu
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Yang Wu
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Gang Zhu
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Yafei Xue
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Yan Qu
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
| | - Tianzhi Zhao
- grid.233520.50000 0004 1761 4404Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, No. 569 Xinsi Road, Xi’an, Shaanxi Province 710038 People’s Republic of China
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Ye K, Li Y, Xing Y, Liu K, Zhou F, Tian Y, Zhang Y. A Randomized Study on the Prophylactic Use of Acetaminophen to Prevent Fever after the Removal of Drainage Tubes for Lumbar Surgery. Orthop Surg 2022; 15:440-447. [PMID: 36444953 PMCID: PMC9891992 DOI: 10.1111/os.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many inpatients encounter a fever in the first 24 h after drainage removal. It is costly to exclude the possibility of deep infection and cultures usually fail to identify the etiology. We hypothesize that the fever is caused by a normal inflammatory response and tested whether the prophylactic use of acetaminophen could reduce the fever rate. METHODS This was a prospectively randomized clinical trial performed from July 2019 to January 2020. A total of 183 consecutive patients undergoing lumbar spine surgery were prospectively randomized into two groups. Ninety-one patients were randomized into the study group; they received oral acetaminophen before removal of the drainage tubes and a second dose at 8 p.m. on the same day. The remaining 92 patients were placed in the control group, and they were given routine treatment without acetaminophen. The two groups were compared for differences in age, sex, height, weight, BMI, surgical segments, surgical time, blood loss, blood transfusion, ASA score, duration of drainage, total volume of the drainage, variation of WBC and CRP, hospital stay after the removal of the drainage tube and the rate of fever. Student's t-test and the Mann-Whitney U test were used to analyze the continuous data, while the chi-square test was used for the analysis of the ranked data. RESULTS Regarding the comparisons of basic information, there were no significant differences between the two groups for age, height, weight, BMI, surgical segments, surgical time, blood loss, blood transfusion, total drainage volume, duration of drainage, hospital stay, WBC, and CRP variation or the duration of hospital stay after removal of the drainage tube (all p > 0.05). However, the fever rate was significantly different (p = 0.006), and the fever rate of the study group (14/91, 15.38%) was significantly lower than that of the control group (30/92, 32.61%). In the study group, there were no complications related to the use of acetaminophen during the hospital stay or during the outpatient follow-up period. CONCLUSION Fever after removal of tube drainage is caused by a normal inflammatory response, and a small dose of acetaminophen could significantly reduce the possibility of fever.
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Affiliation(s)
- Kaifeng Ye
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
| | - Yan Li
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
| | - Yong Xing
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
| | - Kaixi Liu
- Anesthesiology DepartmentPeking University Third HospitalBeijingChina
| | - Fang Zhou
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
| | - Yun Tian
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
| | - Yanping Zhang
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchPeking University Third HospitalBeijingChina
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Ha CM, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Kong DS. Graded Reconstruction Strategy Using a Multilayer Technique Without Lumbar Drainage After Endoscopic Endonasal Surgery. World Neurosurg 2021; 158:e451-e458. [PMID: 34767991 DOI: 10.1016/j.wneu.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al. 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multilayer closing technique, is generally recommended. However, LD occasionally has complications including postpuncture headache, overdrainage symptoms, and increased length of stay. We retrospectively evaluated the outcome of our graded reconstruction strategy using a multilayer technique with a novel material, without LD, after EES. METHODS Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap were placed; for grade III CSF leak, a multilayer technique was used in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap. Postoperatively, routine LD was not performed. RESULTS This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. At follow-up (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement without significant risks.
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Affiliation(s)
- Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Badhiwala J, Lumba-Brown A, Hawryluk GWJ, Ghajar J. External Lumbar Drainage following Traumatic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Neurosurgery 2021; 89:395-405. [PMID: 34171100 DOI: 10.1093/neuros/nyab181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) often results in elevations in intracranial pressure (ICP) that are refractory to standard therapies. Several studies have investigated the utility of external lumbar drainage (ELD) in this setting. OBJECTIVE To evaluate the safety and efficacy of ELD or lumbar puncture with regard to immediate effect on ICP, durability of the effect on ICP, complications, and neurological outcomes in adults with refractory traumatic intracranial hypertension. METHODS A systematic review and meta-analysis were conducted beginning with a comprehensive search of PubMed/EMBASE. Two investigators reviewed studies for eligibility and extracted data. The strength of evidence was evaluated using GRADE methodology. Random-effects meta-analyses were performed to calculate pooled estimates. RESULTS Nine articles detailing 6 studies (N = 110) were included. There was moderate evidence that ELD has a significant immediate effect on ICP; the pooled effect size was -19.5 mmHg (95% CI -21.0 to -17.9 mmHg). There was low evidence to indicate a durable effect of ELD on ICP up to at least 24 h following ELD. There was low evidence to indicate that ELD was safe and associated with a low rate of clinical cerebral herniation or meningitis. There was very low evidence pertaining to neurological outcomes. CONCLUSION Given preliminary data indicating potential safety and feasibility in highly selected cases, the use of ELD in adults with severe TBI and refractory intracranial hypertension in the presence of open basal cisterns and absence of large focal hematoma merits further high-quality investigation; the ideal conditions for potential application remain to be determined.
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Affiliation(s)
- Jetan Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Brain Performance Center, Stanford University, Stanford, California, USA
| | | | - Jamshid Ghajar
- Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, California, USA
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Tan J, Song R, Huan R, Huang N, Chen J. Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis. BMC Neurol 2020; 20:303. [PMID: 32799821 PMCID: PMC7429471 DOI: 10.1186/s12883-020-01877-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Lumbar drainage (LD) is a common method of treating CSF leakage. But whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Clarity on the appropriate use of LD is needed. Methods A systematic literature review was conducted in the PubMed, EMBASE, and Web of science databases. Articles were included when they compared intraoperative LD with intraoperative no-LD CSF leakage rates during pituitary adenomas transsphenoidal surgery. Results Overall, 5 studies containing 678 cases met the inclusion criteria. When data were provided on intraoperative CSF leakage rates, the meta-analysis showed a significant difference in favor of intraoperative LD. When data were provided on postoperative CSF leakage rates, the meta-analysis also demonstrated a significant difference in favor of intraoperative LD. Conclusions Although the results of this meta-analysis suggest intraoperative LD can reduce the risk of CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery, the available evidence is indefinite. To some extent the results suggest intraoperative LD’s potential positive role. Further studies that include well-designed prospective, randomized controlled clinical trials are necessary for further verification.
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Affiliation(s)
- Jiahe Tan
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Rui Song
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Renzheng Huan
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Ning Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jin Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Gao B, Zhang Y, Ouyang J, Tai B, Cao X, Hu S. Surgical removal of a retained lumbar-drainage catheter. Neurochirurgie 2020; 66:408-409. [PMID: 32777232 DOI: 10.1016/j.neuchi.2020.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- B Gao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China
| | - Y Zhang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China
| | - J Ouyang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China
| | - B Tai
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China
| | - X Cao
- Department of Otolaryngology & Head and Neck Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China
| | - S Hu
- Department of Otolaryngology & Head and Neck Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, 650032 Kunming, Yunnan, China.
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Wang P, Song W, Cheng S, Shuai Y, Yang J, Luo S. Establishment of a Nomogram for Predicting Lumbar Drainage-Related Meningitis: A Simple Tool to Estimate the Infection Risk. Neurocrit Care 2020; 34:557-565. [PMID: 32779128 DOI: 10.1007/s12028-020-01076-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar drainage (LD) is one of the common treatment techniques in neurosurgery. There is a risk of secondary meningitis when using this modality. We aim to predict the probability of the complication by designing a nomogram. METHODS A retrospective study was conducted in a teaching hospital. Data were collected and LD-related meningitis (LDRM) was identified, mainly based on clinical manifestations and cerebrospinal fluid analysis. Univariate analysis was used to screen the risk factors, and binary logistic analysis was performed to build the prediction model, which was furtherly transferred into a nomogram. The prediction performance was evaluated by receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and nomogram calibration plot. Internal validation was processed by using ordinary bootstrapping. RESULTS A total of 273 patients who match the research criteria were enrolled, in which 37 cases (13.6%) were confirmed to have LDRM. Univariate analysis showed the risk factors included diabetes (p = 0.003), admission on surgical intensive care unit (p = 0.012), duration time (p < 0.001), site leakage (p < 0.001), and craniotomy (p < 0.001). In multivariate analysis, four of the variables were identified as independent risk factors to establish a prediction model, and a graphical nomogram was designed. The area under the ROC curve was 0.837, and the p value in the Hosmer-Lemeshow test was 0.610, with a mean absolute error in the calibration plot calculated as 0.022. The indices in the testing set were in good accordance with the original set when internal validation was performed. CONCLUSIONS This is the first study to transform the prediction model of LDRM into a nomogram, which can be considered as a tool for clinicians to assess infection risk.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China
| | - Weizheng Song
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China
| | - Yongxiao Shuai
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China
| | - Jiao Yang
- Department of Infection Control, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, 611130, China.
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Liu B, Wang Y, Zheng T, Liu S, Lv W, Lu D, Chen L, Chen L, Ma T, Gao G, Qu Y, He S. Effect of Intraoperative Lumbar Drainage on Gross Total Resection and Cerebrospinal Fluid Leak Rates in Endoscopic Transsphenoidal Surgery of Pituitary Macroadenomas. World Neurosurg 2019; 135:e629-e639. [PMID: 31881340 DOI: 10.1016/j.wneu.2019.12.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We sought to assess whether controlled, intraoperative lumbar drainage (LD) of cerebrospinal fluid (CSF) could facilitate resection of pituitary macroadenomas and reduce the rate of CSF leak. METHODS A retrospective cohort study from a prospective database was conducted on 189 patients with pituitary macroadenoma who received endoscopic transsphenoidal surgery between 2013 and 2017. Patients were classified into 2 groups: 119 patients received an intraoperative LD (LD group) and 70 patients underwent routine endoscopic surgery without LD (control group). In the LD group, lumbar catheters were placed preoperatively and CSF was drained intermittently during tumor resection. The rates of gross total resection (GTR) and CSF leaks were assessed both intraoperatively and postoperatively. RESULTS Intraoperative LD was associated with a higher rate of GTR (92.4% in the LD group vs. 78.6% in the control group, P = 0.006), especially in macroadenomas with suprasellar extension (90.3% vs. 75.0%, P = 0.012). Both intraoperative and postoperative CSF leak rates were significantly decreased in the LD group (intraoperative: 10.1% vs. 31.4%, P < 0.001; postoperative: 3.4% vs. 11.4%, P = 0.035). In functioning adenomas, a better remission rate of excess-hormone secretion was observed in the LD group compared with the controls (89.1% vs. 60.6%, P = 0.001). Patients in the LD group also had an enhanced recovery with a shorter postoperative length of stay (7 days vs. 5 days, P = 0.020). CONCLUSIONS Intraoperative LD may assist surgeons during endoscopic transsphenoidal resection of pituitary macroadenomas by achieving a higher rate of GTR and a lower rate of perioperative CSF leaks. Validation in prospective randomized controlled studies is needed.
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Affiliation(s)
- Bolin Liu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tao Zheng
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shujuan Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wenhai Lv
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Dan Lu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lei Chen
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Long Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tao Ma
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shiming He
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi Province, China; Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
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12
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Fan S, Chen Y, Cao Y, Liu L, Liu F, Zhang C, Zhou L. The Effectiveness of Lumbar Drainage in the Management of Delayed or Recurrent Cerebrospinal Fluid Leaks: A Retrospective Case Series in a Single Center. World Neurosurg 2019; 129:e845-50. [PMID: 31212030 DOI: 10.1016/j.wneu.2019.06.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Little is known about the effectiveness of lumbar drainage (LD) in the treatment of delayed or recurrent cerebrospinal fluid (CSF) leaks. We report our institutional experience and the effectiveness of LD in the management of delayed or recurrent CSF leaks. METHODS Between January 2014 and December 2018, a total 21 patients with delayed or recurrent CSF leaks were enrolled in the research. All patients were treated conservatively for 48 hours, and LD was prescribed if CSF leaks still existed after 48 hours. If LD failed, endoscopic endonasal surgery (EES) was performed as soon as possible. Medical records were collected to analyze the effectiveness of LD. RESULTS Among 21 patients, 4 patients experienced resolution with conservative treatment, and 17 patients were treated by CSF diversion by LD. The total cure rate of LD was 9/17 (52.9%). The cure rate was not statistically significantly different (relative risk = 3.33; Fisher exact test P = 0.131) between the traumatic group (8/12, 66.7%) and the transsphenoidal surgery group (1/5, 20.0%). During the follow-up time, no recurrence of CSF leaks was observed. CONCLUSIONS The cure rate of LD in delayed or recurrent CSF leaks was lower than that of initial treatment with LD. The cure rate in the traumatic group tended to be higher than that in the transsphenoidal surgery group. EES can be used as a remedial treatment for patients in whom LD has failed.
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Qi M, Huang T, Xu L, Wang N, Zhang P, Hu X. A Spinal Subdural Hematoma Induced by Guidewire-based Lumbar Drainage in a Patient with Ruptured Intracranial Aneurysms. Open Med (Wars) 2019; 14:247-250. [PMID: 30847402 PMCID: PMC6401395 DOI: 10.1515/med-2019-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
We present a rare case of spinal subdural hematoma induced by guidewire-based lumbar drainage in a subarachnoid hemorrhage patient with a ruptured intracranial aneurysm. Decreased muscle strength and muscle tension of bilateral lower limbs were noted, and an MRI confirmed the spinal subdural hematoma from the sacral to the thoracic segments. The spinal subdural hematoma evacuation and spinal canal decompression were performed by laminectomy. However, the patient did not benefit from the surgery and developed lower limb muscle atrophy. The complication of the spinal subdural hematoma after lumbar drainage is extremely rare; only limited approaches are available for the treatment of spinal hematoma to improve the outcome and avoid severe consequences. Thus, the present case might suggest refraining from use of a guidewire during lumbar drainage for the prevention of spinal subdural hematoma and close observation of the related symptoms and signs for the early detection of spinal hematoma after the procedure. In addition, full decompression can be performed by complete hematoma evacuation and laminectomy of related segments for the treatment of spinal subdural hematoma induced by lumbar drainage.
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Affiliation(s)
- Meng Qi
- Department of Neurosurgery, Chongqing Emergency Medical Center, The Fourth People’s Hospital of Chongqing, No.1 Jiankang Road, Yuzhong District, Chongqing 400014, Chongqing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Huang
- Department of Neurosurgery, Chongqing Emergency Medical Center, The Fourth People’s Hospital of Chongqing, No.1 Jiankang Road, Yuzhong District, Chongqing 400014, Chongqing, China
| | - Lei Xu
- Department of Neurosurgery, Chongqing Emergency Medical Center, The Fourth People’s Hospital of Chongqing, No.1 Jiankang Road, Yuzhong District, Chongqing 400014, Chongqing, China
| | - Ning Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peipei Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Hangzhou, China
- Tel: +86-571-87070910, Fax: +86-57187070910
| | - Xi Hu
- Department of Neurosurgery, Chongqing Emergency Medical Center, The Fourth People’s Hospital of Chongqing, No.1 Jiankang Road, Yuzhong District, Chongqing 400014, Chongqing, China
- Tel: +86-571-87070910, Fax: +86-57187070910
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14
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Kim YS, Kim SH, Jung SH, Kim TS, Joo SP. Brain stem herniation secondary to cerebrospinal fluid drainage in ruptured aneurysm surgery: a case report. Springerplus 2016; 5:247. [PMID: 27026940 PMCID: PMC4771686 DOI: 10.1186/s40064-016-1875-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND A lumbar drainage catheter is frequently placed intra-operatively to decrease fluid pressure on the brain in aneurysmal subarachnoid cases. In rare cases, this catheter placement can lead to intracranial hypotension, resulting in brain stem herniation termed "brain sag" and it can lead to neurological injury and may prove to be fatal. We present our patient with brain sag secondary to intraoperative lumbar drainage. CASE DESCRIPTION A 56-year-old woman was admitted with a sudden onset of severe headache. A computed tomography (CT) scan revealed diffuse subarachnoid hemorrhage with ruptured anterior communicating artery aneurysm. After general anesthesia, a lumbar drainage catheter was placed intra-operatively to reduce pressure on the brain and 50 cc of CSF was removed during a 5-h period. Three to five days after operation, her neurologic symptoms became worse with an altered mental state and pupillary asymmetry. CT and magnetic resonance imaging (MRI) showed slit lateral ventricles, effacement of the cisterns and an elongated brain stem. After placing the patient in the Trendelenburg position, the patient rapidly recovered to her baseline neurologic state. DISCUSSION Typical complications of subarachnoid hemorrhage such as vasospasm or hydrocephalus also manifest as neurological deterioration, but their treatments differ greatly from those for brain sag. Thusly, it is important to distinguish between causes. Treatments such as lumbar or extra-ventricular drainage, induced hypertension or administration of mannitol must be stopped once brain sag is suspected. Also, care should be taken for typical imaging features of brain sag on CT or MRI scan. For brain sag, placing the patient in the Trendelenburg position can improve neurological status in a rapid fashion. CONCLUSIONS Brain sag is a rare but serious condition and can be fatal if not rapidly diagnosed and treated. We therefore recommend including brain sag in the differential diagnosis, along with vasospasm, hydrocephalus or cerebral edema as part of possible complications following subarachnoid hemorrhage treatment. We hope our clinical and imaging data from this case study contribute to the correct diagnosis of brain sag, as its early detection is important.
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Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital Biomedical Research Institute, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Sung-Hyun Kim
- Department of Neurosurgery, Chonnam National University Hospital Biomedical Research Institute, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Seung-Hoon Jung
- Department of Neurosurgery, Chonnam National University Hospital Biomedical Research Institute, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital Biomedical Research Institute, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital Biomedical Research Institute, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
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15
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Wolf ME, Eisele P, Schweizer Y, Alonso A, Gass A, Hennerici MG, Szabo K. Intracranial Hypertension as an Acute Complication of Aseptic Meningoencephalitis with Leptomeningeal Contrast Enhancement on FLAIR MRI. Case Rep Neurol 2016; 8:10-5. [PMID: 26889150 PMCID: PMC4748806 DOI: 10.1159/000442973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case of a 19-year-old woman who developed intracranial hypertension as an unusual clinical complication of severe aseptic meningoencephalitis probably due to a diminished cerebrospinal fluid reabsorption capacity or leptomeningeal transudation as a consequence of blood-brain barrier dysfunction. These severe inflammatory changes were accompanied by prominent leptomeningeal contrast enhancement best visualized on fluid-attenuated inversion recovery magnetic resonance imaging. In such a prolonged course, a continuous lumbar drainage might be a temporary option to provide rapid symptom relief to the patient.
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Affiliation(s)
- Marc E Wolf
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Yvonne Schweizer
- Department of Neurosurgery, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael G Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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16
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Park S, Yang N, Seo E. The effectiveness of lumbar cerebrospinal fluid drainage to reduce the cerebral vasospasm after surgical clipping for aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc 2015; 57:167-73. [PMID: 25810855 PMCID: PMC4373044 DOI: 10.3340/jkns.2015.57.3.167] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 07/21/2014] [Accepted: 12/15/2014] [Indexed: 11/28/2022] Open
Abstract
Objective Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups. Conclusion LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.
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Affiliation(s)
- Soojeong Park
- Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Narae Yang
- Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Euikyo Seo
- Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea
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17
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Hong CK, Kim YB, Hong JB, Lee KS. Sealing of cerebrospinal fluid leakage during conventional transsphenoidal surgery using a fibrin-coated collagen fleece. J Clin Neurosci 2015; 22:696-9. [PMID: 25630424 DOI: 10.1016/j.jocn.2014.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/15/2014] [Indexed: 11/25/2022]
Abstract
The prevention of cerebrospinal fluid (CSF) leakage is a key feature of the transsphenoidal approach (TSA) to the pituitary fossa. Although fibrin-coated collagen fleece (Tachosil, Nycomed, Linz, Austria) is a powerful topical hemostatic agent whose usage is increasing in open neurosurgery, the use of Tachosil in TSA surgery has not yet gained wide clinical acceptance. We retrospectively evaluated whether the lone use of Tachosil without additional packing material or postoperative lumbar drainage was effective to prevent CSF leakage in TSA surgery in 101 patients. Additionally, we compared it to a conventional sellar closure technique in 54 patients. Only two (1.9%) of the patients in the Tachosil application group developed postoperative CSF rhinorrhea. No other postoperative complications occurred, including infection or material detachment. However, in the conventional packing group, five (9.3%) patients developed postoperative CSF rhinorrhea and one (1.9%) developed meningitis during the postoperative period. The mean length of postoperative hospital stay was significantly shorter in the Tachosil treatment group than in the standard closure group. These results may indicate that sellar repair using Tachosil can be effective to prevent CSF leakage after TSA surgery, and obviate the need for an autologous tissue graft or postoperative lumbar drainage.
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Affiliation(s)
- Chang Ki Hong
- Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea.
| | - Je Beom Hong
- Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea
| | - Kyu Sung Lee
- Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea
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18
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Yong CI, Hwang SK, Kim SH. The role of lumbar drainage to prevent shunt-dependent hydrocephalus after coil embolization for aneurysmal subarachnoid hemorrhage in good-grade patients. J Korean Neurosurg Soc 2010; 48:480-4. [PMID: 21430972 DOI: 10.3340/jkns.2010.48.6.480] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/10/2010] [Accepted: 12/29/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. METHODS One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. RESULTS One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. CONCLUSION Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.
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Affiliation(s)
- Cho In Yong
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Seoul, Korea
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