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Early recognition of lumbar overdrainage by lumbo-ventricular pressure gradient.
MedLine Citation:
PMID:  21273925     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Lumbar drainage (LD) represents a promising treatment strategy for prevention of vasospasm after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE:: To report on transient herniation caused by lumbar overdrainage in three patients with severe SAH, treated with early LD within an ongoing feasibility study. METHODS:: Patients with first-time aneurysmal SAH received LD within 72h from symptom onset, after aneurysm clipping or coiling. LD with a target drainage amount of 5-10ml was continued for 6-9 days. External ventricular drainage (EVD) was inserted on admission when hydrocephalus was present. With both catheters in place, intracranial and lumbar pressure were monitored simultaneously. RESULTS:: Three of 22 patients developed a progressive lumbo-vetricular pressure gradient likely due to cerebrospinal fluid overdrainage. Two patients showed signs of herniation. Clamping of LD resulted in complete reversal of symptoms. The lumbo-ventricular pressure gradient started evolving at least 12h before clinical symptoms occurred, and gradually disappeared in all three patients after LD clamping. CONCLUSION:: Lumbar overdrainage should be avoided in severe SAH, and lumbo-ventricular pressure measurement possibly represents a useful monitoring tool. Herniation due to lumbar overdrainage is a feared complication that can be avoided by using a strict LD management protocol.
Dimitre Staykov; Verena Speck; Bastian Volbers; Ingrid Wagner; Marc Saake; Arnd Doerfler; Stefan Schwab; Juergen Bardutzky
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-26
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Neurology, University of Erlangen; and 2Department of Neuroradiology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
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