Duration of Cerebrospinal Fluid Drainage in Patients With Aneurysmal Subarachnoid Hemorrhage for Prevention of Symptomatic Vasospasm and Late Hydrocephalus

Objective: The effects of repeated lumbar puncture and continuous lumbar cistern drainage on the cognitive function of patients with aneurysmal subarachnoid hemorrhage were compared and analyzed. Methods: Retrospective analysis was performed on 59 patients with aneurysmal subarachnoid hemorrhage treated at our Neurosurgery Department between October 2017 and October 2018. According to the hemorrhagic cerebrospinal fluid drainage mode after aneurysm clipping, the patients were divided into the following two groups: the repeated lumbar puncture drainage (Group A, n = 28) and continuous lumbar cistern drainage (Group B, n = 31). Before and 1 month after surgery, the cognitive function of the patients was scored using the Montreal Cognitive Assessment Scale. Scores of 27~30 were defined as normal, and scores of < 27 as cognitive impairment. Results: The incidences of cognitive impairment were 46% (13/28) and 32% (10/31) for Groups A and B, respectively, before surgery, but the difference was not significant ( P > 0.05). The incidences of cognitive impairment were 35% (10/28) and 12% (4/31) for Groups A and B, respectively, at 1 month after surgery, with significant difference ( P < 0.05). Conclusion: Compared with repeated lumbar puncture, continuous lumbar cistern drainage for aneurysmal subarachnoid hemorrhage significantly reduced the incidence of cognitive impairment after aneurysm clipping.

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Effect of cerebrospinal fluid drainage on clinical outcomes following aneurysmal subarachnoid hemorrhage

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.12.026 ◽

2022 ◽

Vol 97 ◽

pp. 1-6

Author(s):

Luis C. Ascanio ◽

Raghav Gupta ◽

Yaw Tachie-Baffour ◽

Kohei Chida ◽

Adam A. Dmytriw ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebrospinal Fluid Drainage

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Spinal cerebrospinal fluid drainage for prevention of vasospasm in aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled study

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.228512 ◽

2018 ◽

Vol 13 (2) ◽

pp. 238 ◽

Cited By ~ 4

Author(s):

SachinAnil Borkar ◽

Manmohanjit Singh ◽

ShashankSharad Kale ◽

Ashish Suri ◽

PoodipediSarat Chandra ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Randomized Controlled Study ◽

Controlled Study ◽

Cerebrospinal Fluid Drainage ◽

Randomized Controlled

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Plasma Platelet-Activating Factor–Acetyl Hydrolase Activity and the Levels of Free Forms of Biomarker of Lipid Peroxidation in Cerebrospinal Fluid of Patients With Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/neu.0b013e3182333c69 ◽

2011 ◽

Vol 70 (3) ◽

pp. 602-609 ◽

Cited By ~ 11

Author(s):

Yutaka Hirashima ◽

Masaru Doshi ◽

Nakamasa Hayashi ◽

Shunro Endo ◽

Yoko Akazawa ◽

...

Keyword(s):

Lipid Peroxidation ◽

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Acyl Chain ◽

Platelet Activating Factor ◽

Prostaglandin F2α ◽

Fatty Acyl ◽

Fatty Acyl Chain ◽

Symptomatic Vasospasm

Abstract Background: Free radicals and lipid peroxidation are thought to be related to the vasospasm generation after subarachnoid hemorrhage (SAH). Plasma platelet-activating factor-acetyl hydrolase (PAF-AH) degrades phospholipids with an oxidatively modified fatty acyl chain. Objective: To compare plasma PAF-AH activity and free forms of biomarker of lipid peroxidation in cerebrospinal fluid (CSF) between patients with and without symptomatic vasospasm (SVS) after SAH. Methods: The identification of PAF-AH in CSF was performed by Western blotting. The genotype at position 279 of the plasma PAF-AH gene was determined. The activities of PAF-AH and the levels of free 8-iso-prostaglandin F2α (free isoPs), free hydroxyoctadecadienoic acid (free HODE), and free hydroxyeicosatetraenoic acid (free HETE) in CSF were measured. Results: The PAF-AH in CSF was confirmed to be only the plasma type. The genotype of the plasma PAF-AH was not different between patients with and without SVS. Free isoPs, free HODE, and free HETE showed higher values in patients without SVS in 0 to 4 days and 5 to 9 days after SAH. The PAF-AH activity also was higher in patients without SVS in 0 to 4 days and 5 to 9 days after SAH. The associations between PAF-AH activity and free isoPs, and between PAF-AH activity and free HODE were significant. Conclusion: Oxidized lipids of lipoproteins and blood cell membranes produced by reactive oxygen species in CSF when SAH occurs may be the main source of lipid peroxidation. Plasma PAF-AH can hydrolyze oxidized phospholipids, and may attenuate the spreading of lipid peroxidation and participate in defense mechanisms against vasospasm after SAH.

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Sphingosine 1-phosphate levels in cerebrospinal fluid after subarachnoid hemorrhage

Neurological Research and Practice ◽

10.1186/s42466-020-00093-x ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Anika Männer ◽

Dominique Thomas ◽

Marlies Wagner ◽

Jürgen Konczalla ◽

Helmuth Steinmetz ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Neurological Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Arteries ◽

High Sensitivity ◽

Control Subjects ◽

Symptomatic Vasospasm ◽

Significant Difference ◽

Hemorrhage Volume

Abstract Background and purpose Sphingosin-1-phosphate (S1P) plays a crucial role as a signaling molecule in the immune system and the vasculature. Previous studies suggested a role as a vasoconstrictor of cerebral arteries via the S1P3-Receptor. Cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of disability and poor neurological outcome. Early detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients. The aim of this prospective case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome. Methods S1P levels in CSF of 18 control subjects and 18 SAH patients with placement of an external ventricular drainage (EVD) were determined by high sensitivity mass spectrometry from day 1 through 14 after SAH onset. Hemorrhage volume, development of asymptomatic vasospasm (aVS) and symptomatic vasospasm (sVS), and neurological outcome were correlated to day 1 S1P levels. Results The intrathecal S1P levels of SAH patients were higher than those of the control subjects, and correlated with hemorrhage volume. There was no significant difference in S1P levels between patients with aVS and those with sVS. S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale. Conclusion S1P levels were highest directly after placement of the EVD and correlated strongly with hemorrhage volume, which may be caused by the intrathecal clot and subsequent lysis of red blood cells, an important source of S1P. We did not detect a second peak of S1P release over the course of the intensive care period.

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