Lumbar Drainage Of Cerebrospinal Fluid For Subarachnoid Hemorrhage (Review)

Objectives:To assess the efficacy and safety of lumbar drainage of CSF in patients with SAH.Methods:The Cochrane systematic review method was used to evaluate to the Randomized Controlled Trial(RCT) of lumbar drainage of CSF in patients with SAH. The searching strategy included:Cochrane Central Register of Controlled Trials(CENTRAL), PubMed, China Biological Medicine Database(CBM), Chinese National Knowledge Infrastructure(CNKI), Wanfang Database, EMBASE(Excerpt Medica Database), Chinese Science and Technique Journals Database(CSTJ), the China Doctor&Master Dissertation Full-text Database, the Chinese Proceedings of Conference Full-text Database, International Clinical Trials Registry Platform (ICTRP), Chinese Clinical Trials Registry, Google Scholar, ClinicalTrials.gov Database, Current Controlled Trials and the reference lists of related articles. Two reviewers independently selected, assessed quality of studies and extracted data. The RevMan5.2software was used for statistical analysis.Results:We included13RCTs involving1165patients. The methodology quality of most of the trials was poor. The poor outcome of the SAH patients at the end of long-term follow-up (at least six months) were reported only in one of the studies. Meta-analysis of fatality showed a better effect of lumbar drainage of CSF therapy in patients with SAH than the control group with statistical significance [RR=0.36, 95%CI(0.21,0.61)]. Meta-analysis of complications also showed a better effect of lumbar drainage of CSF therapy in patients with SAH than the control group with statistical significance (except re-bleeding)[cerebral vasospasm RR=0.26,95%CI(0.18,0.37); hydrocephalus RR=0.30,95%CI(0.17,0.55)]. Some trials reported the adverse events of lumbar drainage of CSF therapy including cerebral hernia, infection and intracranial hypotension reaction.Conclusion:With relatively poor quality of most of included trials, insufficient evidence is obtained to support the conclusion that lumbar drainage of CSF therapy is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidence.