The Relationship Between The Duration Of Lumbar Drainage And Shunt-dependent Chronic Hydrocephalus In ASAH Patients After Aneurysm Clipping

Background and Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) is aworld-wide disease with high morbidity and mortality. The factors that related tothe prognosis of aSAH include early and late complications in addition to thedangers of surgical clipping and coil embolization. The early complications ofaSAH comprise rebleeding, symptomatic vasospasm and acute hydrocephalus,while the late ones shunt-dependent chronic hydrocephalus(SDCH) and delayedcerebral ischemia(DCI).It’s well known that preventing and managing of theearly and late complications of aSAH to improve the prognosis of aSAH are thehot topics of modern neurosurgery. Although there are many hypothesesaccounting for the genesis of complications as SVS, SDCH and AH of aSAH,the main pathophysiological factors that related to aSAH are the blood cells andtheir degenerative products in the subarachnoid cavity. There’s no doubt thatblocking the disturbing of blood cell products to the secretion, absorption andcirculation of cerebrospinal fluid (CSF) would ultimately decrease theprevalence of most complications and improve the prognosis after aSAH.Besides, some articles imply that the duration, amount and method of CSFdraining do affect the prognosis of aSAH patients. The most papers studying theduration and amount of CSF draining are about cisternal or external ventriculardrainage, while the lumbar drainage is so scarce. Extended drainage of CSFcould increase the rate of SDCH after aSAH in addition to retrograde infection.So appropriate duration of lumbar drainage is essential to aSAH patients. Thisstudy try to identify whether duration of lumbar draining affect the rate ofSDCH in aSAH patients after surgical clipping and the optimal duration, through a retrospective analyzing the clinical records on admition and inhospital.Materials and Methods: In this study we retrospectively analyzing theinpatients with aSAH of the First Hospital of Jilin University, in whom thediagnosis of aneurysm were achieved by CTA from January2009to October2010.It includes143males and192females. According to our exclusion criteria,213patients were retained, including97males and116females aged from23to78.The Patients were divided into three groups according to their age group,87cases of the young (aged20~39),73cases of the middle-aged (aged40~59),53cases of the elderly (aged≥60years).Accompanied by symptoms of abdominalpain, bloating, diarrhea, abdominal mass and anemia. The clinical manifestationsand demographic data of the patients on admission were recorded by the primaryneurosurgeons. Once diagnosed with aneurysm, the patient would undergosurgical clipping via pterional approach. A lumbar draining catheter would beindwelled in each patient after general anesthesia. Statistical analysis wasperformed using SPSS17.0. The categorical variables were analyzed withchi-square test or Fisher exact and P≤0.05was considered statisticallysignificant. The variables that with statistical significance were further analyzedusing logistic regression analysis. OR values,95%confidence intervals and Pvalues of the variables with logistic regression analysis were listed.Result:1.Age（P=0.031）, intraventricular hemorrhage（P＜0.001）, Hunt-Hessgrade（P=0.001）,Modified Fisher Scale（P=0.001）,Glasgow Coma Scale（P=0.037）, duration of lumbar drainage（P=0.026）were considered related with SDCH using χ2test（table3.1）, while gender（P=0.076）,initial acutehydrocephalus were not.2.Longer duration of lumbar CSF drainage was relatedwith lower incidence（P=0.004）of symptomatic SVS usingχ2test（table3.2）.3.There was no statistical significance（P=0.945）in the proportion of lumbarCSF draining duration between the different groups of Modified Fisher Scale.4. Duration of lumbar CSF drainage, initial Hunt-Hess grade, initial ModifiedFisher Scale and initial Glasgow Coma Scale are all independent risk factors ofSDCH in aSAH patients who were treated with clipping surgery.Conclusion:1.Duration of lumbar CSF drainage, initial Hunt-Hess grade, initialModified Fisher Scale and initial Glasgow Coma Scale are all independent riskfactors of SDCH in aSAH patients who were treated with clipping surgery, whileage, gender, acute hydrocephalus on admission were not.2. Longer duration oflumbar CSF drainage was associated with higher incidence of SDCH in aSAHpatients who were treated with clipping surgery, while lower in the occurrenceof SVS.3. It is essential to find a valid intervening method and an appropriateduration of lumbar CSF drainage to prevent SDCH and SVS at the same time.