The Effectiveness of Lumbar Cerebrospinal Fluid Drainage to Reduce the Cerebral Vasospasm after Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage

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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Cerebrospinal Fluid Tenascin-C in Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e31822aa1f2 ◽

2011 ◽

Vol 23 (4) ◽

pp. 310-317 ◽

Cited By ~ 30

Author(s):

Hidenori Suzuki ◽

Kenji Kanamaru ◽

Masato Shiba ◽

Masashi Fujimoto ◽

Kyoko Imanaka-Yoshida ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tenascin C

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Concentrations of estradiol, progesterone and testosterone in sefrum and cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage correlate weakly with transcranial Doppler flow velocities

BMC Neuroscience ◽

10.1186/s12868-021-00634-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jan Martin ◽

Eva Plank ◽

Bernhard Ulm ◽

Jens Gempt ◽

Maria Wostrack ◽

...

Keyword(s):

Blood Flow ◽

Cerebrospinal Fluid ◽

Cerebral Blood Flow ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Transcranial Doppler ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Arteries ◽

Blood Flow Velocities ◽

Flow Velocities

Abstract Background The implication of the steroids estradiol, progesterone and testosterone in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) has not been comprehensively assessed. In rodents, studies suggested beneficial effects of steroids on cerebral vasospasm after experimental SAH. Studies in humans are warranted, however, a general dilemma of human studies on neuroactive substances is that the brain is not directly accessible and that concentrations in the periphery may not adequately parallel concentrations in the central compartments. In the present study, concentrations of estradiol, progesterone and testosterone in serum and cerebrospinal fluid (CSF) of patients with aSAH were determined. Blood flow velocities in cerebral arteries were measured by transcranial Doppler sonography (TCD). The aim of this study was to evaluate the correlations between the cerebral blood flow velocities and levels of estradiol, progesterone and testosterone in CSF and serum. Results Samples of serum and CSF of 42 patients with aSAH were collected concomitantly daily or every other day via the arterial line and the external ventricular drainage for two weeks after the hemorrhage. Blood flow velocities in the cerebral arteries were determined by TCD. Total estradiol, progesterone and testosterone concentrations were measured by electro-chemiluminescence immunoassay. The strength of correlation was assessed by Spearman’s rank correlation coefficient. The correlation analysis revealed very weak correlations between cerebral blood flow velocities and concentrations of estradiol, progesterone and testosterone levels in both compartments with correlation coefficients below 0.2. Conclusions In humans with aSAH, merely very weak correlations between flow velocities in cerebral arteries and concentrations of estradiol, progesterone and testosterone in serum and CSF were demonstrated. These results suggest a limited influence of the respective steroids on cerebral vascular tone although vasodilatory effects were described in rodent studies. Thus, the implication of steroids in processes of neurological deterioration warrants further clarification.

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