Efficacy of lumbar CSF drainage in reducing intracranial blood volume measured by CT scans among patients with aneurysmal subarachnoid hemorrhage
Robert Mertens (Berlin), Mohammad Asif Iqbal (Berlin), Zoe Shaked (Berlin), Katharina Kersting (Berlin), Kiril Krantchev (Berlin), Anastasia Janas (Berlin), Jawed Nawabi (Berlin), Peter Vajkoczy (Berlin), Stefan Wolf (Berlin)
The EARLYDRAIN randomized trial demonstrated that the application of a lumbar drainage (LD) following aneurysmal subarachnoid hemorrhage (aSAH) reduces the burden of secondary infarction and decreases the rate of unfavorable outcomes (1). The underlying pathophysiological reason for outcome improvement remained unclear. We investigated the hypothesis that an additional lumbar drain leads to faster removal of subarachnoid blood from the intracranial space, compared to no drainage or drainage via EVD only.
Longitudinal non-contrast-enhanced CT scans of 68 patients participating in EARLYDRAIN from a single institution were manually segmented using the ITK-SNAP tool. CT imaging was performed solely on clinical indication, and timing was not mandated in the study protocol. Basal SAH, cortical SAH, subdural hematoma, intracerebral and intraventricular hemorrhage were quantified. The decline in CT blood volume over time was analyzed according to actual treatment with or without a lumbar drain and compared with generalized additive models.
A total of 28 patients with 133 CT scans were treated with LD and 40 patients with 216 CT scans were treated without LD. No significant difference was found for demographic data between both groups. Total hemorrhage burden in the CT scan on admission was unevenly distributed among all patients, with a median of 29.1 ml (range 4.4 ml to 100.0 ml). No significant difference was noted between the LD and NoLD groups concerning initial hemorrhage volume after SAH (p=0.14). LD use led to a faster reduction of total blood volume in the first 14 days (p=0.0003), with a maximum difference in CT scans performed between day 3 and 5. This decline was most prominent in the cortical SAH blood volume (p=0.0027), and lesser in the intraventricular (p=0.069), basal SAH (p=0.073), parenchymal (p=0.11) and subdural (p=0.277) components.
In this preliminary analysis of the CT scans from roughly one-fourth of patients recruited in the EARLYDRAIN trial, lumbar drains appear to contribute to a more rapid reduction of intracranial blood volume measured by CT. This may indicate a potential mechanism serving as explanation for the improved outcome by early application of a lumbar drain in patients with aneurysmal SAH. Further analysis is warranted.
Wolf S, et al: JAMA Neurol 2023; 80(8):833-842We use cookies on our website. Cookies are small (text) files that are created and stored on your device (e.g., smartphone, notebook, tablet, PC). Some of these cookies are technically necessary to operate the website, other cookies are used to extend the functionality of the website or for marketing purposes. Apart from the technically necessary cookies, you are free to allow or not allow cookies when visiting our website.